Marjolin's ulcer: a rare entity with a call for early diagnosis

Malignant melanoma arising in a burn scar

Secondary malignancies are rare but devastating complications of longstanding burn scars. Squamous cell carcinoma is the most common, followed by basal cell carcinoma and melanomas. There are fewer than 50 total reported cases of malignant melanomas arising in burn scars. We report a case of malignant melanoma arising within a longstanding burn scar confirmed by histology, FISH, and PRAME staining to further characterize melanomas arising in burn scars and to illustrate the diagnostic challenges they present.

Management Dilemma in a Large Fungating Squamous Cell Carcinoma Over a Marjolin's Ulcer on the Chest Wall Coexisting With Severe Post-Burn Contracture of the Neck

Marjolin's ulcer is a premalignant condition occurring over scars and chronically inflamed tissue. Squamous cell carcinoma is the most common malignancy associated with Marjolin's ulcer. The progression of disease and metastasis is relatively slow due to scarring and meagre lymphatic and vascular supply over these scars. We present a case of a large fungating squamous cell carcinoma in a patent having a burn scar over his chest as well as having post-burn contracture of the neck, posing problems in management due to intubation issues. We managed him unconventionally with serial excision under local anesthesia and skin grafting of the wound.

Aggressive Acute Marjolin’s Ulcer Arising in a Burn Scar

Marjolin's ulcer is one of the clinical variants of squamous-cell carcinoma. It is a highly aggressive disease that develops from chronic wounds. Almost 65% of these lesions have been diagnosed on underlying burn scars. Although the mean latency time between the primary lesion and the apparition of the ulcer is around 25 years, some cases with an early debut have been described. Squamous-cell carcinomas arising in chronic wounds are typically aggressive and are related with a poor prognosis due to their late diagnosis. Therefore, it is important to recognize symptoms that indicate malignant degeneration of chronic wounds, allowing the clinician to make an early diagnosis in order not to delay the surgical treatment that is required to improve the global survival of the patient. The time elapsed between our patient's burn and the appearance of Marjolin's ulcer was only 7 months, drawing attention to its fast and aggressive progression.

Marjolin Ulcers of the Scalp Post Trauma and of the Neck Post Radiation, Diagnosis, and Reconstruction

What are potential causes of Marjolin ulcer and how do they present?How are MU diagnosed?What are differential diagnoses for MU, and what can help differentiate them?What are the appropriate treatments for MU?

Non-healing Wound After Mastopexy: Cautionary Case Report for a Unique Source of a Marjolin's Ulcer of the Breast

Marjolin’s ulcers (MUs) represent a unique degenerative process that results in malignancy. Classically, sites of previous burns are associated with MU but, in fact, any non-healing wound has been found to be a potential source of degeneration. Malignancies that arise include typically cutaneous squamous cell carcinoma (SCC), but SCC at the site of a previous wound is a more aggressive, lethal variant. This report represents a cautionary case of the management of an open wound and highlights a previously undescribed etiology of an MU in the breast.

The hallmarks of cancer are also the hallmarks of wound healing

The Hanahan and Weinberg "hallmarks of cancer" papers provide a useful structure for considering the various mechanisms driving cancer progression, and the same might be useful for wound healing. In this Review, we highlight how tissue repair and cancer share cellular and molecular processes that are regulated in a wound but misregulated in cancer. From sustained proliferative signaling and the activation of invasion and angiogenesis to the promoting role of inflammation, there are many obvious parallels through which one process can inform the other. For some hallmarks, the parallels are more obscure. We propose some new prospective hallmarks that might apply to both cancer and wound healing and discuss how wounding, as in biopsy and surgery, might positively or negatively influence cancer in the clinic.

Squamous Cell Carcinoma Arising from a Morel-Lavallée Lesion: A Case Report

CASE

A 72-year-old man presented 20 years after a Morel-Lavallée (ML) lesion with pain and drainage. Biopsies of the lesion and lymph nodes were positive for squamous cell carcinoma (SCC). There was no cutaneous involvement or distant metastasis. After chemotherapy and radiation, he underwent resection of the lesion and lymph nodes with flap closure. Two months postoperatively, he unfortunately developed malignant pleural effusions, hypercalcemia, and kidney injury and was eventually transferred to hospice care and died.

CONCLUSION

This is the first report of SCC arising from a ML lesion. Chronic ML lesions should be treated aggressively and monitored for transformation into malignancy, even without cutaneous involvement.

[Diagnostic pitfall: Early arising, multiple and recurrent Marjolin's ulcer. About 8 patients (16 tumors) and literature review]

INTRODUCTION

Marjolin's ulcer (MU) is a large entity representing skin cancers resulting from the transformation of chronic wounds of a heterogeneous nature. Burn scars are the most at risk of degeneration, in particular because there are the sites of important skin tension. Atypical forms are not uncommon. The objective of this study is to present these exceptions which are underestimated.

MATERIALS AND METHODS

All patients with UM in our centre between January 2011 and February 2019 have been included permitting to report the initial pathology, the location, the latency time, the histology and the management carried out.

RESULTS

Eight patients were treated in our center for MU, they developed 16 skin cancers. Fourteen were squamous cell carcinomas (SCC). The shortest latency period was 2 months. The youngest patient was 22 years old when she was diagnosed with MU. Three patients had at least 2 synchronous SCC. One patient had a recurrence after a split-thickness skin grafting on artificial dermis and 2 patients had second locations.

CONCLUSION

Atypic forms are not rare. MU is commonly recurrent, multiple, early arising and may appear in young people. The treatment of chronic wounds cannot be dissociated from the treatment of contractures, otherwise the wound will inevitably reappear.

The Pathobiology of Skin Aging: New Insights into an Old Dilemma

Long considered both physiologic and inevitable, skin aging is a degenerative phenomenon whereby both intrinsic and environmental factors conspire to produce an authentic disease. The consequences of this disorder are many and varied, ranging from atrophy and fragility to defective repair to deficient immunity and vulnerability to certain infections. The pathobiologic basis for skin aging remains poorly understood. At a cellular level, stem cell dysfunction and attrition appear to be key events, and both genetic and epigenetic factors are involved in a complex interplay that over time results in deterioration of our main protective interface with the external environment. Past and current understanding of the cellular and molecular intricacies of skin aging provide a foundation for future approaches designed to thwart the aging phenotype. Herein, the authors provide a review of current insights into skin aging, including the mechanisms of skin aging, the role of stem cells in skin aging and the implications of skin aging for the microbiome and for the development of cancer. Conquest of the oft overlooked disease of skin aging should have broad implications that transcend the integument and inform novel approaches to retarding aging and age-related dysfunction in those internal organs that youthful skin was designed to envelop and safeguard.

Malignant Transformation in Diabetic Foot Ulcers-Case Reports and Review of the Literature

An imbalance of regeneration and destruction of the extracellular matrix due to a plethora of chemo- and cytokines, elevated matrix metalloproteinases, bacterial contamination and repetitive painless tissue damage can lead the chronicity of a wound, especially in diabetic foot ulcers (DFU). Along general lines, wound healing and cancer development are similar. Therefore chronic wounds prepare a breeding ground for cancer development. Several characteristics such as increase in size, verrucous everted margins and contact bleeding are suspicious for malignant growth in a chronic wound. While previously the term Marjolin's ulcer was attributed to a malignant tumor in (burn) scars, it is nowadays used for every malignant tumor in chronic wounds. Furthermore, chronic ulcers in diabetic feet are susceptible for malignant transformation. We describe two cases of squamous cell carcinoma in patients with DFU-a 71 year-old woman and a 67 year old man. Both received total tumor excision and split-skin grafts with good short-time results.

Marjolin's ulcer in chronic wounds - review of available literature

Marjolin's ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. Its incidence is estimated to range from 1% to 2% of all burn scars. It most frequently takes the form of squamous cell carcinoma which sometimes is diagnosed during examination of lesions developing in scars and hard-to-heal chronic wounds (pressure sores, leg ulcers). Therapeutic management of Marjolin's ulcer requires well-designed treatment plan to ensure optimal medical care and good quality of life for the patient. The high risk of metastases and damage to the structure of vitally important organs determines the need for early diagnosis and prompt surgical intervention with supplementary therapy. The purpose of the study was to examine etiopathogenesis of Marjolin's ulcer and principles of its treatment. The authors focused on the aspect of malignant degeneration in chronic wounds (leg ulcers, pressure sores) as a very rare, aggressive form of Marjolin's ulcer. A review of the available literature on the issue of Marjolin ulcers was conducted using the key words; Marjolin ulcers, pressure sore, chronic wound. Malignant degeneration in chronic wounds is a very rare aggressive form of Marjolin ulcer. Increased oncological alertness should be displayed by nursing and medical personnel taking care of patients with chronic wounds.

Marjolin's Ulcer Complicating a Pressure Sore: The Clock is Ticking

BACKGROUND

Malignant degeneration in any chronic wound is termed a Marjolin's ulcer (MU). The overall metastatic rate of MU is approximately 27.5%. However, the prognosis of MU specific to pressure sores is poor, with a reported metastatic rate of 61%. This is due to insidious, asymptomatic malignant degeneration, a lack of healthcare provider awareness, and, ultimately, delayed management.

CASE REPORT

An 85-year-old white male was noted by his wound-care nurse to have a rapidly developing growth on his lower back over a period of 4 months. There was history of a non-healing, progressive pressure ulcer of the lower back for the past 10 years. On examination, there was a 4 × 4 cm pressure ulcer of the lower back, with a superimposed 1.5 × 2 cm growth in the superior region. There was an absence of palpable regional lymphadenopathy. Punch biopsy revealed squamous cell carcinoma consistent with Marjolin's ulcer. The ulcer underwent excision with wide margins, and a skin graft was placed. Due to the prompt recognition of an abnormality by the patient's wound-care nurse, metastasis was not evident on imaging. There are no signs of recurrence at 1-year follow-up.

CONCLUSIONS

Marjolin's ulcer has a rapid progression from local disease to widespread metastasis. Therefore, it is essential that wound-care providers are aware of the clinical signs and symptoms of malignant degeneration in chronic wounds.