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Tang MP, Nguyen TTB, Le HTT, Nguyen HQ, Tran NM, Le MHN. Challenging Recurrence and Management of Squamous Cell Carcinoma in the Calcaneal Region: A Case Report. Cureus 2024; 16:e59087. [PMID: 38803760 PMCID: PMC11128329 DOI: 10.7759/cureus.59087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Squamous cell carcinoma (SCC) is the second most common type of skin cancer. As ultraviolet exposure represents an important risk factor, SCC commonly occurs on the face, lips, scalp, hands, and heels. The foot is an unusual location to manifest SCC. In this report, we present a case of a 44-year-old woman with severe local recurrence of SCC in the right heel, four years after an initial excision of a primary, small lesion. For various reasons, the patient did not visit the clinic for follow-up assessment during this period. Considering the extent of the lesion and infection risk, the affected leg was amputated at one-third of the lower leg. This case report underlines the importance of educating patients about the risk of SCC and assisting them in attending follow-up visits. In addition, adequate attention should be given to foot lesions with suspicious appearance. Early detection would minimize systemic risks, including metastasis and infection, and maximize preserved function after surgical intervention.
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Affiliation(s)
- Minh Phuong Tang
- General Surgery Department, Tra Vinh General Hospital, Tra Vinh City, VNM
| | | | - Huyen Thi Thanh Le
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Hien Quang Nguyen
- Cardiovascular Research Department, Methodist Hospital, Merrillville, USA
| | - Nghia Minh Tran
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, VNM
| | - Minh Huu Nhat Le
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, TWN
- Research Center for Artificial Intelligence, College of Medicine, Taipei Medical University, Taipei, TWN
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2
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Wang Y, Pan Z, Cui J, Zhang X, Li D, Sun H, Yang B, Li Y. Adhesive hydrogel releases protocatechualdehyde-Fe 3+ complex to promote three healing stages for accelerated therapy of oral ulcers. Acta Biomater 2024; 178:68-82. [PMID: 38452962 DOI: 10.1016/j.actbio.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
Oral ulcers can significantly reduce the life quality of patients and even lead to malignant transformations. Local treatments using topical agents are often ineffective because of the wet and dynamic environment of the oral cavity. Current clinical treatments for oral ulcers, such as corticosteroids, have limitations and side effects for long-term usage. Here, we develop adhesive hydrogel patches (AHPs) that effectively promote the healing of oral ulcers in a rat model. The AHPs are comprised of the quaternary ammonium salt of chitosan, aldehyde-functionalized hyaluronic acid, and a tridentate complex of protocatechualdehyde and Fe3+ (PF). The AHPs exhibit tunable mechanical properties, self-healing ability, and wet adhesion on the oral mucosa. Through controlling the formula of the AHPs, PF released from the AHPs in a temporal manner. We further show that the AHPs have good biocompatibility and the capability to heal oral ulcers rapidly. Both in vitro and in vivo experiments indicate that the PF released from AHPs facilitated ulcer healing by suppressing inflammation, promoting macrophage polarization, enhancing cell proliferation, and inducing epithelial-mesenchymal transition involving inflammation, proliferation, and maturation stages. This study provides insights into the healing of oral ulcers and presents an effective therapeutic biomaterial for the treatment of oral ulcers. STATEMENT OF SIGNIFICANCE: By addressing the challenges associated with current clinical treatments for oral ulcers, the development of adhesive hydrogel patches (AHPs) presents an effective approach. These AHPs possess unique properties, such as tunable mechanical characteristics, self-healing ability, and strong adhesion to the mucosa. Through controlled release of protocatechualdehyde-Fe3+ complex, the AHPs facilitate the healing process by suppressing inflammation, promoting cell proliferation, and inducing epithelial-mesenchymal transition. The study not only provides valuable insights into the healing mechanisms of oral ulcers but also introduces a promising therapeutic biomaterial. This work holds significant scientific interest and demonstrates the potential to greatly improve the treatment outcomes and quality of life for individuals suffering from oral ulcers.
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Affiliation(s)
- Yue Wang
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, China
| | - Ziyi Pan
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, China
| | - Jing Cui
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, China
| | - Xu Zhang
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, China
| | - Daowei Li
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, China.
| | - Hongchen Sun
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, School and Hospital of Stomatology, Jilin University, China
| | - Bai Yang
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, China; Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, China
| | - Yunfeng Li
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, China; Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, China.
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3
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Chan EL, Rovira A. Head-and-neck Cancer in the Emergency Department: A Contemporary Review of Common Presentations and Management. J Emerg Trauma Shock 2024; 17:33-39. [PMID: 38681881 PMCID: PMC11045002 DOI: 10.4103/jets.jets_40_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/21/2023] [Accepted: 12/04/2023] [Indexed: 05/01/2024] Open
Abstract
Head-and-neck cancer (HNC) can present with life.threatening symptoms in the emergency department. Patients can sometimes be misdiagnosed with pulmonary disease due to similar signs and symptoms, ultimately leading to delayed diagnosis and potentially devastating consequences. Reasons for this include lack of awareness of patient risk factors and knowledge of the myriad of presenting complaints in the disease process among physicians working in primary care and in the emergency department. This article explores the contemporary risk factors and common presenting symptoms and discusses initial management for a patient with potential head-and-neck malignancy. Emergency presentations of HNC are wide ranging and can overlap with common respiratory pathologies. Clinician awareness of this can assist the team in deciding what appropriate examination and investigations are required to reduce the risk of delaying diagnosis and further treatment.
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Affiliation(s)
- Ee Lyn Chan
- Department of Anesthesia, Maidstone and Tunbridge Wells Hospital, Royal Tunbridge Wells, Maidstone, UK
| | - Aleix Rovira
- Department of Head and Neck Surgery, Guy's and St. Thomas' Hospital, Great Maze Pond, London, UK
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4
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Huang CY, Hsieh ZY, Chang KC, Chang DH. Marjolin's ulcer in an ischial pressure sore presented with necrotizing soft tissue infection: A case report. Medicine (Baltimore) 2023; 102:e33450. [PMID: 37000064 PMCID: PMC10063310 DOI: 10.1097/md.0000000000033450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
RATIONALE Marjolin's ulcer (MU) is a rare skin malignancy derived from a chronic wound. Pressure ulcer related MU possesses poor prognosis and high metastatic rate, and it is difficult to be differentiated, especially when superimposed infection. PATIENT CONCERNS Here we report a case with pressure ulcer related MU which presented as necrotizing soft tissue infection (NSTI) to demonstrate the manifestation, treatment, and prognosis of this rare disease. DIAGNOSES A 45-year-old male patient had spinal cord injury at age 2 years. He presented ischial pressure sore complicated with NSTI initially. After serial debridements and antibiotic treatment, the infection subsided. For the persistent verruca-like skin lesion, he underwent wide excision which revealed well-differentiated squamous cell carcinoma. Further image studies showed localized residual tumor without distant metastasis. INTERVENTIONS He then underwent hip disarticulation and anterior thigh fillet flap reconstruction. Local recurrence developed 3 months later, and re-wide excision and inguinal lymph node dissection were performed. No lymph node metastasis was noted and adjuvant radiotherapy was given. OUTCOMES He was followed for 34 months and no recurrence or metastasis was found. The patient can move with a wheelchair or a hip prosthesis, and is partially dependent for daily activities. LESSONS MU can masquerade as NSTI and one should be alert to its malignant potential. Due to its aggressive nature, limb sacrifice can be considered in circumstances of profound involvement. As for the reconstruction method, pedicled fillet flap provided good wound coverage.
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Affiliation(s)
- Ching-Yen Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hosptial, New Taipei, Taiwan
| | - Zhoa-Yu Hsieh
- Division of Medical Imaging, Department of Radiology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Ke-Chung Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hosptial, New Taipei, Taiwan
| | - Dun-Hao Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hosptial, New Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Mousa AK, Elshenawy AA, Maklad SM, Bebars SMM, Burezq HA, Sayed SE. Post-burn scar malignancy: 5-year management review and experience. Int Wound J 2021; 19:895-909. [PMID: 34535972 PMCID: PMC9013596 DOI: 10.1111/iwj.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
The study spotlights a severe uncommon post‐burn complication, Marjolin's ulcer, in upper Egypt plastic and wound care centres. This problem is mainly related to inadequate medical care and awareness. No community or race is immune. The underlying malignant transformation mechanism remains unclear. The study aims, according to our experience, to review the prognostic factors through the management protocol of Marjolin's ulcers. This prospective study was conducted in the Aswan University Plastic & Burn surgery department in South Egypt between 2013 and 2020 and investigated 226 patients with chronic post‐burn ulceration. Nineteen cases were proved to have Marjolin's ulcer, and the other cases that had been excluded from being malignant went for reconstruction with split‐thickness skin graft with/without flap after adequate ulcer debridement. The surgical, oncologic, radiologic indications, and prognostic factors were reviewed according to our management outcome—the assessment with follow‐up period extended over 5 years. Histopathology of ulcers ranged among mild, moderate, and poorly differentiated squamous cell carcinoma. One scalp ulcer case showed basosquamous pathology. Most cases presented at age above 50, but no age was immune. The mean latent period was 29 years on average. The lesions' sites varied in their anatomic location where they involved the upper extremity, the scalp, and the lower extremity that had a predilection. Although surgical excision is the primary management line for tumour ablation, other factors may change the management course. During the follow‐up period, neoplasm recurrence in the form of lymph node enlargement and/or locoregional metastasis was detected in eight cases. Within 1 year after the intervention, six recurrent cases died, and two were saved. In addition to the case study, this paper reviewed the literature and provided our team a good experience in light of the NCCN protocol for non‐melanotic cutaneous carcinoma, although we suffered limited medical resources. It is concluded that early accurate diagnosis, low‐grade malignancy, and well‐planned individualised surgery with adjuvant radiotherapy were the best prognostic factors. The close follow‐up for an early sign of disease recurrence is paramount.
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Affiliation(s)
- Ahmed K Mousa
- Plastic & Reconstructive Surgery - Medical School of Aswan University, Aswan, Egypt
| | | | - Salah M Maklad
- Radiology Department, Medical School of Aswan University, Aswan, Egypt
| | - Shaimaa M M Bebars
- Department of Clinical Pathology, Medical School of Aswan University, Aswan, Egypt
| | - Hisham A Burezq
- Consultant Plastic & Reconstruction - Ibn Sina Hospitals - AlBabtain Center for Burn & Plastic Surgery, Kuwait City, Kuwait
| | - Sherif E Sayed
- Surgical Oncology, Medical School of Bany-Swif University, Bany-Swif, Egypt
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6
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Immune Checkpoint Inhibition in Marjolin Ulcer: A Case Series. J Immunother 2021; 44:234-238. [PMID: 34100836 DOI: 10.1097/cji.0000000000000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/04/2021] [Indexed: 11/25/2022]
Abstract
Immunotherapy has revolutionized the treatment of advanced cutaneous squamous cell carcinoma. However, the role of immune checkpoint inhibitors for the treatment of Marjolin ulcer (MU), a rare cutaneous malignancy that arises from previously traumatized and chronically inflamed skin, is not well defined. Thus, efficacy and clinical response to immunotherapy in patients with MU requires further investigation. MU with squamous cell carcinoma, the most commonly associated malignancy, is highly aggressive with a greater risk for lymph node and distant metastasis compared with non-MU cutaneous squamous cell carcinoma. Often associated with nonhealing chronic wounds from burn scars, injuries, venous stasis ulcers, osteomyelitis, and radiotherapy, MU carries a poor prognosis. We conducted a retrospective study and describe a single institution experience of patients with MU treated with anti-programmed cell death protein 1 (PD-1) therapy at Massachusetts General Hospital between 2016 and 2020. Five subjects with this rare presentation met inclusion criteria and were treated with pembrolizumab (N=2) or cemiplimab (N=3). Four subjects received immunotherapy in the first-line setting. Notably, 1 patient had durable disease control for 1 year while on immunotherapy, with continued disease control after the cessation of anti-PD-1 therapy. Of the 4 patients that progressed on anti-PD-1 therapy, disease control at 5 months was achieved in 2 patients. Furthermore, 60% overall survival (3 patients) was observed in this limited cohort at 12 months after initiating anti-PD-1 therapy for MU. We describe the clinicopathologic features and clinical outcomes of our MU-SCC cohort.
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Kanth AM, Heiman AJ, Nair L, Giammarino A, Carpenter C, Ricci JA, Patel A. Current Trends in Management of Marjolin's Ulcer: A Systematic Review. J Burn Care Res 2021; 42:144-151. [PMID: 32805009 DOI: 10.1093/jbcr/iraa128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Marjolin's ulcer (MU) is a rare, aggressive entity with frequent delay in diagnosis for a variety of regions. Although well described and classically taught in medical school, aspects of its treatment remain ill-defined and controversial. A systematic review was performed according to PRISMA guidelines to identify studies discussing patients who underwent surgical treatment of MU. A total of 31 papers, reporting on 1016 patients, were included. Burns were the most common etiology of malignant degeneration (68%), followed by trauma. The lower extremity was most affected (51%) and Squamous Cell Carcinoma (SCC) was found in 94% of cases, with the majority being well differentiated. Basal cell carcinoma and melenoma composed a minority of cases. Melanoma occurred more frequently in previously skin grafted wounds and had a higher rate of metastases than SCC. Most patients did not have associated regional or distant metastases present at diagnosis. Wide local excision (71%) was performed in most cases, unless amputation was indicated for severe disease or bone involvement. Lymphadenectomy and sentinel lymph node biopsy were variably reported, with conflicting evidence on the efficacy. Lymphadenectomy was most commonly indicated for known lymph node involvement. In cases of metastatic disease chemotherapy and radiation were used in conjunction with surgical treatment. Despite numerous articles on this topic, controversy remains in the management of MU. Early diagnosis of suspicious chronic wounds and prompt surgical intervention remains imperative to its treatment.
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Affiliation(s)
| | | | | | | | | | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Bronx, New York
| | - Ashit Patel
- Division of Plastic Surgery, Albany Medical Center
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Kasai T, Isayama T, Sekido M. Squamous cell carcinoma arising from an ischial pressure ulcer initially suspected to be necrotizing soft tissue infection: A case report. J Tissue Viability 2021; 30:621-625. [PMID: 33461827 DOI: 10.1016/j.jtv.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pressure ulcers are the most common complications in bedridden patients or those with spinal cord injuries. Marjolin's ulcer refers to a malignant transformation arising from burn scars or chronic nonhealing wounds-such as pressure ulcers-over many years. Squamous cell carcinoma is the major histopathologic type of Marjolin's ulcer, and the gold standard for diagnosis is tissue biopsy. Medical professionals may have difficulty distinguishing pressure ulcers from Marjolin's ulcer, especially when the latter presents with invasive infections. Thus, malignant transformations arising from pressure ulcers are frequently overlooked. Herein, we describe a case of squamous cell carcinoma arising from pressure ulcers on the left ischium, which was initially identified as a necrotizing soft tissue infection. CASE REPORT A 59-year-old paraplegic patient presented with stage 3 left ischial pressure ulcer, which involves full-thickness skin loss and extends into deep subcutaneous tissue, and arrived at our hospital with suspected sepsis. Upon physical examination, the patient presented with fever and shivering. Initial examination and imaging findings revealed the presence of necrotizing soft tissue infections. Three weeks later, rapid increase in granulation in the deep part of the ulcer was observed. Samples from multiples ulcer sites were collected for tissue biopsy. Finally, histological examination revealed well-differentiated squamous cell carcinoma. The patient received radiation therapy and chemotherapy and died 11 months after the diagnosis. CONCLUSION Malignant transformations arising from pressure ulcers may closely resemble pressure ulcer infections. In these cases, tissue biopsies should be performed during primary care for the infection to exclude malignant transformations.
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Affiliation(s)
- Takehiro Kasai
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Mito Medical Center, Ibaraki, 311-3193, Japan.
| | - Tetsuya Isayama
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Mito Medical Center, Ibaraki, 311-3193, Japan
| | - Mitsuru Sekido
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8576, Japan
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Burusapat C, Wanichjaroen N, Wongprakob N, Satayasoontorn K. Characteristics of Marjolin's Ulcers in 21st Century: A Retrospective Study, Systematic Review, and Surgical Guideline Recommendation. J Burn Care Res 2020; 42:152-166. [PMID: 33128365 DOI: 10.1093/jbcr/iraa196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Marjolin's ulcer is rare and aggressive malignancy. The objective was to conduct a review of Marjolin's ulcer cases to gain a better understanding and its management. A retrospective study of patients with Marjolin's ulcers at our hospital between 2010 and 2019 was conducted. For the systematic review, the electronic database of the National Library of Medicine was searched and articles published between 2000 and 2019 were included. A total of 14 patients were included in the retrospective study. Twelve patients were male. The mean age was 59.71 years. The latency period was 27.78 years. The most common malignancy was squamous cell carcinoma, and 71.43% had developed on the lower extremities. Well-differentiated squamous cell carcinomas occurred in 38.46% of the cases Rates of lymphovascular and perineural invasion were 30.77 and 23.08%, respectively. Results from the literature search yielded 80 case reports (91 cases) and 42 retrospective reviews (1216 cases). Most cases were male and the most common location was lower extremities. The latency period for the acute and chronic periods was 2.75 months and 20.75 years, respectively. The most common malignancy was squamous cell carcinoma (92.27% in the retrospective reviews) and 59.98% of the cases exhibited well-differentiation. Rates of regional lymph node involvement and distant metastases were 10.20 and 12.09%, respectively. Marjolin's ulcer in 21st century is not so rare. The most common is well differentiated squamous cell carcinoma. Early flap surgery or skin grafts for chronic ulcers or burn scars are recommended to reduce risk. Guideline for surgical management is established.
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Affiliation(s)
- Chairat Burusapat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Nutthapong Wanichjaroen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Nuttadon Wongprakob
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Kantang Satayasoontorn
- Department of Pathology and Laboratory Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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Nicoara M, Bain K, Patel R, Jaikaran O, Hingorani A, Asher E. Malignant Transformation of Nonhealing Ulcer-Basal Cell Carcinoma. Ann Vasc Surg 2020; 70:565.e7-565.e10. [PMID: 32035267 DOI: 10.1016/j.avsg.2020.01.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/09/2020] [Accepted: 01/26/2020] [Indexed: 11/17/2022]
Abstract
We discuss the rare case of a 72-year-old female with a history of a nonhealing lower extremity ulcer that was biopsied, revealing malignant transformation to basal cell carcinoma (BCC). Although BCC is the most common malignancy worldwide, malignant transformation of nonhealing wounds is more often associated with squamous cell carcinoma. Current literature estimates the rate of BCC arising from venous stasis ulcer to occur between 1.5 and 15%. When diagnosed early, BCC can have cure rates of up to 95%. However, metastatic BCC has a median survival of roughly 8 months. We believe it is important to raise awareness of this rare, but often curable, clinical diagnosis to improve long-term outcomes.
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Affiliation(s)
- Michael Nicoara
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY.
| | - Kevin Bain
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
| | - Ronak Patel
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
| | - Omkaar Jaikaran
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
| | - Anil Hingorani
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
| | - Enrico Asher
- Department of Vascular Surgery, NYU Langone Hospital - Brooklyn Brooklyn, NY
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Guan Y, Wang G, Fails D, Nagarajan P, Ge Y. Unraveling cancer lineage drivers in squamous cell carcinomas. Pharmacol Ther 2020; 206:107448. [PMID: 31836455 PMCID: PMC6995404 DOI: 10.1016/j.pharmthera.2019.107448] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Abstract
Cancer hijacks embryonic development and adult wound repair mechanisms to fuel malignancy. Cancer frequently originates from de-regulated adult stem cells or progenitors, which are otherwise essential units for postnatal tissue remodeling and repair. Cancer genomics studies have revealed convergence of multiple cancers across organ sites, including squamous cell carcinomas (SCCs), a common group of cancers arising from the head and neck, esophagus, lung, cervix and skin. In this review, we summarize our current knowledge on the molecular drivers of SCCs, including these five major organ sites. We especially focus our discussion on lineage dependent driver genes and pathways, in the context of squamous development and stratification. We then use skin as a model to discuss the notion of field cancerization during SCC carcinogenesis, and cancer as a wound that never heals. Finally, we turn to the idea of context dependency widely observed in cancer driver genes, and outline literature support and possible explanations for their lineage specific functions. Through these discussions, we aim to provide an up-to-date summary of molecular mechanisms driving tumor plasticity in squamous cancers. Such basic knowledge will be helpful to inform the clinics for better stratifying cancer patients, revealing novel drug targets and providing effective treatment options.
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Affiliation(s)
- Yinglu Guan
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Guan Wang
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Danielle Fails
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Yejing Ge
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
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12
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Marjolin Ulcer: A Report of 2 Cases of Squamous Cell Carcinoma Arising From Posttraumatic Soft-Tissue Scarring. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:81-83. [PMID: 31615629 DOI: 10.1016/j.ad.2018.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/02/2018] [Accepted: 06/07/2018] [Indexed: 11/21/2022] Open
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13
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Dávila Osorio V, Méndez Gaviria L, Amador Patarroyo J, González M. Marjolin Ulcer: A Report of 2 Cases of Squamous Cell Carcinoma Arising From Posttraumatic Soft-Tissue Scarring. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2018.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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15
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Zhu D, Zhang X, Zhang D, Li T, Yang C. RETRACTED: Extranodal natural killer/T-cell lymphoma masquerading a diabetic foot ulcer. Diabetes Res Clin Pract 2018; 137:208-212. [PMID: 29407271 DOI: 10.1016/j.diabres.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/17/2018] [Indexed: 11/23/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief due to an author reporting that they were listed without their permission.
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Affiliation(s)
- Di Zhu
- Department of Endocrinology, Air Force General Hospital of P.L.A, China
| | - Xiaotian Zhang
- Department of Cardiology, 75600 Military Hospital of P.L.A, China
| | - Da Zhang
- Department of Endocrinology, Air Force General Hospital of P.L.A, China
| | - Teng Li
- Department of Pathology, Air Force General Hospital of P.L.A, China
| | - Caizhe Yang
- Department of Endocrinology, Air Force General Hospital of P.L.A, China.
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Acute Marjolin's Ulcer in a Postauricular Scar after Mastoidectomy. Case Rep Otolaryngol 2017; 2016:2046954. [PMID: 28050297 PMCID: PMC5168475 DOI: 10.1155/2016/2046954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 12/11/2022] Open
Abstract
Background. Marjolin's ulcer is a rare, aggressive cutaneous malignancy that arises primarily in burn scars but can occur in other types of scars. Squamous cell carcinoma is the most common variant, and while malignant degeneration usually takes a long time, it can develop acutely. Case Report. a 30-year-old man who developed Marjolin's ulcer acutely in a right postauricular scar after mastoidectomy and the incision and drainage of a mastoid abscess. To the best of our knowledge, this report is the first to describe a Marjolin's ulcer in a postauricular surgical scar. However, it has been reported in others areas in the head and neck. Conclusion. Marjolin's ulcer is most commonly observed after postburn scars, but it may be observed after any type of scars, as our patient developed an SCC with a postsurgical scar. Early diagnosis is essential, and a biopsy should be performed on any nonhealing wound or chronic wound that undergoes a sudden change. Tissue samples should be taken from both the centre and the margins of the wound.
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Iacopi E, Coppelli A, Goretti C, Loggini B, Piaggesi A. Type 2 diabetic patient with a foot ulcer as initial manifestation of diffuse large B-cell lymphoma: A case report. Diabetes Res Clin Pract 2016; 115:130-2. [PMID: 26809905 DOI: 10.1016/j.diabres.2016.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/30/2015] [Accepted: 01/07/2016] [Indexed: 01/22/2023]
Abstract
Diabetic foot ulcerations (DFU) represent a major cause of hospitalization and amputation. In people with diabetes it's not uncommon to find chronic wounds due to pathogenic mechanisms different from diabetes. Here we report the case of a foot lesion misdiagnosed as DFU but actually caused by diffuse large B-cell lymphoma.
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Affiliation(s)
- Elisabetta Iacopi
- Diabetic Foot Section, Medicine Department, Pisa University Hospital, Pisa, Italy.
| | - Alberto Coppelli
- Diabetic Foot Section, Medicine Department, Pisa University Hospital, Pisa, Italy
| | - Chiara Goretti
- Diabetic Foot Section, Medicine Department, Pisa University Hospital, Pisa, Italy
| | - Barbara Loggini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, Pisa University Hospital, Pisa, Italy
| | - Alberto Piaggesi
- Diabetic Foot Section, Medicine Department, Pisa University Hospital, Pisa, Italy
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Scatena A, Zampa V, Fanelli G, Iacopi E, Piaggesi A. A Metastatic Squamous Cell Carcinoma in a Diabetic Foot. INT J LOW EXTR WOUND 2016; 15:155-7. [DOI: 10.1177/1534734616640358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 72-year-old male was referred to our hospital for a plantar ulceration that had occurred many years earlier. The lesion, with exuberant granulation and large areas of necrosis and fibrin, had long been treated by plastic surgeons with no positive evolution. At admission in our hospital no ischemia was detected, and foot radiograph was negative for bone involvement. The patient underwent a foot magnetic resonance imaging, which showed high vascularization in the plantar region and early capture of the contrast medium. We then performed multiple biopsies of the ulceration that revealed a moderately differentiated squamous cell carcinoma. The total body computed tomography exam raised a systemic involvement. A lymph node biopsy and immunohistochemistry assay on the pleural cytological sample proved the presence of a primary squamous cell carcinoma of the foot with systemic dissemination. Although rare, squamous cell carcinoma could be associated with chronic nonhealing ulcers; therefore, when a lesion does not heal, despite adequate standard treatment, its etiopathogenesis should be challenged.
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Affiliation(s)
- Alessia Scatena
- Diabetic Foot Section, Department of Medicine, Pisa University Hospital
| | - Virna Zampa
- Imaging Department, Pisa University Hospital
| | | | - Elisabetta Iacopi
- Diabetic Foot Section, Department of Medicine, Pisa University Hospital
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, Pisa University Hospital
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[Marjolin's ulcer. A 10 year experience in a diabetic foot unit]. CIR CIR 2015; 84:340-3. [PMID: 26259738 DOI: 10.1016/j.circir.2015.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/02/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Marjolin's ulcer is defined as the appearance of a neoplasm within a chronic wound. The most common histological type is squamous. A total of 2 cases treated in our hospital are presented. CLINICAL CASE Case 1. A 71 year old man who presented with redness and suppuration from the wounds he had in his right foot after an electric shock 40 years earlier. The radiology showed involvement of the 4° and 5° metatarsal. Supracondylar amputation was performed, showing a well-differentiated invasive squamous cell carcinoma. CASE 2 A 56 year old male, paraplegic for 20 years. He was treated due to an infected right heel ulcer, with partial improvement, but the ulcers persisted. Biopsy was performed, reporting as epidermoid carcinoma. Infracondylar amputation was performed. The diagnosis was a well-differentiated squamous cell carcinoma infiltrating the dermis. CONCLUSION The prevalence of Marjolin's ulcer is 1.3-2.2% of all ulcers. Diagnosis is difficult, so biopsy is recommended on any suspicious lesion or ulcer that has received conservative treatment for one month without improvement, although this time limit is not clear. The treatment is the surgery. Local excision with a margin of an inch is enough. If the ulcer is extensive, amputation is required. Survival is estimated between 66 and 80% at 2 years, with recurrence rates of 23%. Unfavourable factors are poor tumour differentiation and metástasis, appearing in 20% of cases.
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Nunan R, Harding KG, Martin P. Clinical challenges of chronic wounds: searching for an optimal animal model to recapitulate their complexity. Dis Model Mech 2015; 7:1205-13. [PMID: 25359790 PMCID: PMC4213725 DOI: 10.1242/dmm.016782] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The efficient healing of a skin wound is something that most of us take for granted but is essential for surviving day-to-day knocks and cuts, and is absolutely relied on clinically whenever a patient receives surgical intervention. However, the management of a chronic wound – defined as a barrier defect that has not healed in 3 months – has become a major therapeutic challenge throughout the Western world, and it is a problem that will only escalate with the increasing incidence of conditions that impede wound healing, such as diabetes, obesity and vascular disorders. Despite being clinically and molecularly heterogeneous, all chronic wounds are generally assigned to one of three major clinical categories: leg ulcers, diabetic foot ulcers or pressure ulcers. Although we have gleaned much knowledge about the fundamental cellular and molecular mechanisms that underpin healthy, acute wound healing from various animal models, we have learned much less about chronic wound repair pathology from these models. This might largely be because the animal models being used in this field of research have failed to recapitulate the clinical features of chronic wounds. In this Clinical Puzzle article, we discuss the clinical complexity of chronic wounds and describe the best currently available models for investigating chronic wound pathology. We also assess how such models could be optimised to become more useful tools for uncovering pathological mechanisms and potential therapeutic treatments.
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Affiliation(s)
- Robert Nunan
- Schools of Biochemistry and Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK.
| | - Keith G Harding
- School of Medicine, University of Cardiff, Cardiff, CF14 4XN, UK
| | - Paul Martin
- Schools of Biochemistry and Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK. School of Medicine, University of Cardiff, Cardiff, CF14 4XN, UK
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Zhilova MB, Smolyannikova VA. Squamous cell carcinoma in a psoriasis patient after multiple courses of phototherapy. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-1-92-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors present a clinical case study of squamous cell carcinoma in a psoriasis patient after 24 courses of phototherapy (22 courses of PUVA therapy and two courses of mid-wavelength ultraviolet therapy (311 nm)). The malignant neoplasm developed against the background of signs of a chronic photodamage of the skin: lentigo, actinic elastosis, diffuse hyperpigmentation, spotty skin pigmentation.
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Parikh SA, Patel VA, Ratner D. Advances in the management of cutaneous squamous cell carcinoma. F1000PRIME REPORTS 2014; 6:70. [PMID: 25165569 PMCID: PMC4126542 DOI: 10.12703/p6-70] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cutaneous squamous cell carcinoma is one of the most common non-melanoma skin cancers worldwide. While most cutaneous squamous cell carcinomas are easily managed, there is a high-risk subset of tumors that can cause severe morbidity and mortality. Tumor characteristics as well as patient characteristics contribute to the classification of cutaneous squamous cell carcinomas as low-risk vs. high-risk. Advances in the treatment of cutaneous squamous cell carcinomas largely relate to the management of this high-risk subset. Surgical and non-surgical management options, including newer targeted molecular therapies, will be discussed here. Larger, multicenter studies are needed to determine the exact significance of individual risk factors with respect to aggressive clinical behavior and the risks of metastasis and death, as well as the role of surgical and adjuvant therapies in patients with high-risk cutaneous squamous cell carcinomas.
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Affiliation(s)
- Sonal A. Parikh
- Columbia University Department of Dermatology161 Fort Washington Ave. 12th FloorNew York, NY 10032, USA
| | - Vishal A. Patel
- Columbia University Department of Dermatology161 Fort Washington Ave. 12th FloorNew York, NY 10032, USA
| | - Desiree Ratner
- Mount Sinai Beth Israel Cancer Center West325 W. 15th streetNew York, NY 10011, USA
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Abstract
We report the case of a 51-year-old woman with malignant degeneration of a right hallux nail bed ulcer of 20 years' duration. Histologic examination confirmed the diagnostic features of Marjolin's ulcer, a well-defined but uncommon malignant ulcer that occurs in chronic wounds and cutaneous scars. In this report, we describe the clinical and histopathologic features and the differential diagnosis of this unusual lesion.
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Affiliation(s)
- Sasha Pavlovic
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
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Marjolin's ulcer: a preventable malignancy arising from scars. World J Surg Oncol 2013; 11:313. [PMID: 24341890 PMCID: PMC3896958 DOI: 10.1186/1477-7819-11-313] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 12/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Marjolin's ulcer (MU) is a rare malignancy arising from various forms of scars. This potentially fatal complication typically occurs after a certain latency period. This article attempts to reveal the importance of the latency period in the prevention and early treatment of the malignancy. METHODS A retrospective review of 17 MU patients who underwent surgical procedures between June of 2005 and December 2011 was conducted. Etiology of injuries, latency period, repeated ulceration, and outcomes were recorded. This observational report reveals characteristics of patients who develop MU. RESULTS An incidence of 0.7% of MU was found amongst patients complaining of existing scars in our study; burns and trauma were the most common etiology of MU. The mean latency period was 29 years (SD = 19) and the mean post-ulceration period was 7 years (SD = 9). Statistical analysis revealed a negative correlation between the age of patients at injury and the length of latency period (r = -0.8, P <0.01), as well as the lengths of pre-ulceration and post-ulceration periods (r = -0.7, P <0.01). CONCLUSIONS Patients experience different lengths of pre- and post-ulceration periods during the latency period. Younger patients tend to have a longer latency period. Skin breakdown on chronic scars and chronic unhealed ulcers are two main sources of MU. MU may be preventable with a close surveillance of the ulcer during the latency period.
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Yesilada AK, Sevim KZ, Sucu DÖ, Akçal A, Karşidaǧ S, Kilinc L, Kizilkaya HO. Marjolin Ulcer: Clinical Experience with 34 Patients over 15 Years. J Cutan Med Surg 2013; 17:404-9. [DOI: 10.2310/7750.2013.13016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Malignancies that arise from scars are referred to as Marjolin ulcers. The association between chronic ulcers and squamous cell carcinomas is well established. There are many case reports in the literature regarding Marjolin ulcer; however, randomized controlled clinical series that describe a thorough evaluation of these patients are rarely encountered. Objective: We present our clinic's 15 years of experience with 34 Marjolin ulcer patients and their treatment modalities. Methods: A retrospective analysis of 302 squamous cell carcinoma patients who were treated in the plastic surgery department between 1997 and 2011 was performed. Thirty-four (10.3%) histopathologically confirmed Marjolin ulcer patients were further analyzed. Results: Although burn scars represented 77% of the patients in the present study, unstable scars that formed following traffic accidents and fistula tracts are also among the commonly encountered etiologies. Based on our observations, squamous cell carcinoma, in addition to malignant melanoma and verrucous carcinoma, is frequently observed in cases of Marjolin ulcers. Conclusion: If the goal is to eradicate this clinical entity, all of the chronic ulcers that fail to heal require biopsies at regular intervals. Large excisional margins, lymphadenectomies in cases of palpable lymph nodes, and a well-defined oncology protocol are all essential in treating Marjolin ulcer.
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Affiliation(s)
- Aysin Karasoy Yesilada
- From the Department of Plastic and Reconstructive Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Kamuran Zeynep Sevim
- From the Department of Plastic and Reconstructive Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Deniz Özgur Sucu
- From the Department of Plastic and Reconstructive Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Arzu Akçal
- From the Department of Plastic and Reconstructive Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Semra Karşidaǧ
- From the Department of Plastic and Reconstructive Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Leyla Kilinc
- From the Department of Plastic and Reconstructive Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Hazim Orhan Kizilkaya
- From the Department of Plastic and Reconstructive Surgery, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
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Garrido Colmenero C, Martín Castro A, Valenzuela Salas I, Martínez García E, Blasco Morente G, Tercedor Sánchez J. Squamous cell carcinoma in lichen planopilaris. J Dermatol Case Rep 2013; 7:84-7. [PMID: 24133562 DOI: 10.3315/jdcr.2013.1147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 06/08/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lichen planopilaris (LPP) is a rare variant of cutaneous lichen planus that preferentially involves hair follicles. OBSERVATION We describe the case of an 87-year-old woman with cicatricial alopecia due to lichen planopilaris. The diagnosis was based on clinical evaluation, histopathology and trichoscopy. Squamous cell carcinoma developed within the hairless area after 18 years of evolution. CONCLUSION It is necessary to consider the association between lichen planopilaris and squamous cell carcinoma and to ensure a close follow-up of LPP patients, especially when there is a long history of the disease or new a lesion develops, which does not correspond clinically or in trichoscopy to lichen planopilaris.
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Badial PR, Rashmir-Raven AM, Cagnini DQ, Oliveira-Filho JP, Cooley AJ, Cunha PHJ, Kitchell BE, Conceição LG, Mochal CA, Borges AS. Marjolin’s Ulcer in Two Horses with Hereditary Equine Regional Dermal Asthenia. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2012.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Purcell N, Gilles R, Shchelokov S, Hassall M, Vandervord J. Two cases of non-melanocytic skin cancer confused as trauma. ANZ J Surg 2012; 82:91-2. [PMID: 22507513 DOI: 10.1111/j.1445-2197.2011.05940.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pekarek B, Buck S, Osher L. A Comprehensive Review on Marjolin's Ulcers: Diagnosis and Treatment. THE JOURNAL OF THE AMERICAN COLLEGE OF CERTIFIED WOUND SPECIALISTS 2011; 3:60-4. [PMID: 24525526 PMCID: PMC3601857 DOI: 10.1016/j.jcws.2012.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the misnomer, Marjolin's ulcers really reflect malignant degeneration arising within a pre-existing cicatrix or scar. In most instances, biopsied lesions demonstrate well-differentiated squamous cell tumors, although other epidermoid lesions are occasionally encountered. The lesions are rare and are most commonly found in the lower extremity, especially the heel and plantar foot. In light of the close association of these lesions with scarred tissues associated with various chronic lower-extremity wounds, those involved in health care delivery to these patients must be aware of Marjolin's ulcer, its manifestations and potential ramifications.
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Affiliation(s)
- Brian Pekarek
- Ohio College of Podiatric Medicine, Independence, OH 44685, USA
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Erfurt-Berge C, Bauerschmitz J. Malignant tumours arising in chronic leg ulcers: three cases and a review of the literature. J Wound Care 2011; 20:396-400. [DOI: 10.12968/jowc.2011.20.8.396] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C. Erfurt-Berge
- Department of Dermatology, University Hospital Erlangen, Germany
| | - J. Bauerschmitz
- Department of Dermatology, University Hospital Erlangen, Germany
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Abstract
Marjolin ulcer is a well-defined, but uncommon malignant ulcer that occurs in chronic wounds and cutaneous scars. Jean-Nicolas Marjolin was credited with describing this phenomenon in 1828. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis. The malignant transformation of an ulcer is most commonly associated with burn scars, but has been reported in many other types of chronic, non healing wounds such as traumatic wounds, venous stasis and chronic pressure ulcers, fistulas, lacerations and leprosy ulcers. Development of malignancy tends to be slow with an average time of approximately 25 years. Various theories concerning pathogenesis of Marjolin ulcer have been proposed. Well-differentiated squamous cell carcinoma (SCC) is the most common histological type of Marjolin ulcer. Biopsy with histopathologic interpretation remains the gold standard for the diagnosis, with radical surgical excision being the treatment of choice. A high index of suspicion should be held by any health care provider when evaluating a chronic, non healing wound. This is a case report of a Marjolin ulcer arising on the left buttock of a patient with a long-standing history of a traumatic wound.
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Affiliation(s)
- Sasha Pavlovic
- Department of Pathology, College of Medicine, University of Illinois, Chicago, IL 60612, USA.
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Abstract
BACKGROUND Cutaneous malignancies are considered rare among Africans. Trauma, its sequelae, and other chronic non-healing wounds are known to predispose to malignant degeneration. Not much is known of the demographics of Marjolin's ulcers in sub-Saharan Africa. METHODS Pathology records on patients suspected to have Marjolin's ulcers submitted to the Pathology Department were extracted from a database of 75,124 specimens. A review of the English literature on Marjolin's ulcers from Nigeria, a sub-Saharan country, was also performed. RESULTS Of 210 specimens from suspected Marjolin's ulcers, 167 records had a histological diagnosis of malignancy, with a male to female ratio of 1:1.4, and a mean age of 48 years (range: 4-97 years). There were 163 (97.6%) squamous cell carcinomas, 3 (1.8%) sarcomas, and 1 (0.6%) malignant melanoma. Burn scars, chronic ulcers, osteomyelitis, and "other" ulcers constituted 82 (49%), 70 (42%), 9 (5.4%), and 6 (3.6%), respectively. Subjects in six sub-Saharan Marjolin's ulcer studies had a mean age between 36 and 42 years, with a mean latent period 16 years. CONCLUSIONS Marjolin's ulcers in sub-Saharan African have a shorter latent period, and they occur in younger patients. Provision of early stable wound cover is essential for prevention of malignant degeneration of scars, while early appropriate intervention is crucial in the treatment of chronic ulcers.
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Bangash SJ, Green WH, Dolson DJ, Cognetta AB. Eruptive postoperative squamous cell carcinomas exhibiting a pathergy-like reaction around surgical wound sites. J Am Acad Dermatol 2009; 61:892-7. [DOI: 10.1016/j.jaad.2009.01.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/20/2008] [Accepted: 01/25/2009] [Indexed: 10/20/2022]
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Samira Y, Sérgio H, Michalany NS, de Almeida FA, Jane T. Squamous cell carcinoma in chronic ulcer in lepromatous leprosy. Dermatol Surg 2009; 35:2025-30. [PMID: 19732101 DOI: 10.1111/j.1524-4725.2009.01328.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yarak Samira
- Department of Dermatology, Federal University of Vale San Francisco, Petrolina, Brazil.
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Propst JT, Fann SA, Franchini JL, Lessner SM, Rose JR, Hansen KJ, Terracio L, Yost MJ. Focused in vivo genetic analysis of implanted engineered myofascial constructs. J INVEST SURG 2009; 22:35-45. [PMID: 19191156 DOI: 10.1080/08941930802566748] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Successfully engineering functional muscle tissue either in vitro or in vivo to treat muscle defects rather than using the host muscle transfer would be revolutionary. Tissue engineering is on the cutting edge of biomedical research, bridging a gap between the clinic and the bench top. A new focus on skeletal muscle tissue engineering has led investigators to explore the application of satellite cells (autologous muscle precursor cells) as a vehicle for engineering tissues either in vitro or in vivo. However, few skeletal muscle tissue-engineering studies have reported on successful generation of living tissue substitutes for functional skeletal muscle replacement. Our model system combines a novel aligned collagen tube and autologous skeletal muscle satellite cells to create an engineered tissue repair for a surgically created ventral hernia as previously reported [SA Fann, L Terracio, W Yan, et al., A model of tissue-engineered ventral hernia repair, J Invest Surg. 2006;19(3):193-205]. Several key features we specifically observe are the significant persistence of transplanted skeletal muscle cell mass within the engineered repair, the integration of new tissue with adjacent native muscle, and the presence of significant neovascularization. In this study, we report on our experience investigating the genetic signals important to the integration of neoskeletal muscle tissue. The knowledge gained from our model system applies to the repair of severely injured extremities, maxillofacial reconstructions, and restorative procedures following tumor excision in other areas of the body.
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Affiliation(s)
- John T Propst
- Department of Surgery, University of South Carolina, Columbia, South Carolina 29209, USA.
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[The treatment of malignant tumors on venous leg ulcers. Case presentation and literature review]. Hautarzt 2009; 59:912-6. [PMID: 18850078 DOI: 10.1007/s00105-008-1593-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Malignant changes in persistent venous leg ulcers are a grave complication of chronic impaired wound healing. In our case, a venous leg ulcer had persisted on the right calf for 30 years. Exophytic tumors in the ulcer with frequent bleeding prompted biopsies. A squamous cell carcinoma was found, but only in the second biopsy. The surgical procedure was planned so that in a single session both the tumor and the underlying causes of the chronic venous insufficiency in the leg could be treated appropriately. Extirpation of the enlarged lymph nodes in the groin was combined with crossectomy and removal of the long saphenous vein, followed by circular radial excision of the ulcer scar fascia (fasciotomy). The excised tissue was examined histologically. Muscle biopsies were taken from the site of suspicious adhesions of the fascia to the calf muscle. The large, circular defects on the lower leg were covered with the appropriate dressing to condition the wound bed. After three weeks the well-granulated area was covered with meshed split skin grafts. During the operation and in the post-operative phase, machine-assisted and manual decongestion was performed, an established therapy for lymphedema, chronic venous insufficiency and chronic venous ulcers.
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CORRESPONDENCE. Br J Hosp Med (Lond) 2008. [DOI: 10.12968/hmed.2008.69.7.30424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pyrah and colleagues (vol 69(6), 2008, p. 312) argue the need to find a way to learn from complaints by responding to them respectfully and humbly. Criticisms need not become complaints if they are taken as constructive.
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