Figure - available from: Case Reports in Otolaryngology
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Axial CT scan (noncontrast) showing the temporal bone. (a) Bone window and right ill-defined soft tissue density in the right mastoid air cells, middle, and inner ear, associated with bony destruction. Only the basal turn of the cochlea and part of the vestibule are visualized. (b) Soft tissue window and posterior aspect of the tegmentum tympani appear destroyed, thinned, and interrupted, with subcutaneous soft tissue swelling adjacent to the EAC and collection at the superior aspect.
Source publication
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 acu...
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Citations
... [2] The usual age of clinical presentation is 53 to 59 years. [6] Predisposing conditions are of MU are burn eschars, [1] pressure sores, [1] venous stasis ulcers, [1] traumatic wounds, [1] Chronic osteomyelitis, [1],Fistulas, [7] Burn sites are allowed to heal by secondary intention rather than skin graft, [4] repeated trauma especially over flexion crease over many years, [3,4] Dry skin with fragile scar, [4,5]Scars after CABG, [8]and Urethral fistula. [9] Exact pathophysiology behind MU is questionable [1] and controversial [2,3]. ...
... It also helps in the detection of distant lymph nodal metastasis. [8] Macroscopically they are divided into two types as exophytic and infiltrative. The infiltrative form is more aggressive and leads to early metastasis. ...
... [6.7, 10] Early diagnosis and prompt multi-disciplinary approaches are essential for treatment. [2,5,7,8] Local excision with a tumor clearance margin of 2 to 4 cm is the treatment of choice for MU without invasion. [8] For Invasive MU, the treatment of choice is joint amputation above the ulcer. ...
Background: Marjolin’s ulcer (MU) is defined as the malignancy arising from the burn scar or in a chronic ulcer after a certain
period. Any post-burn scar or long-standing ulcer or any condition which causes the chronic irritation of the skin subsequently can
lead to the development of malignancy. MU has the propensity to invade locally and have regional lymph nodal or distant metastasis.
The proper treatment of the underlying skin condition can prevent or at least reduce the incidence of the MU.
Case Presentation
A 54-year-old male came to the hospital with the complaints of mass in the left lower leg, which is gradually increased in the
size for the past 6 months. He had a history of burns in the leg at the age of 5 years which was treated by secondary intention leading
to scar formation and deformity of the leg. He is a farmer by occupation. He had a history of injury with an iron rod while working in
the field before six months. The growth had started developing after that. He is not a known diabetic or hypertensive. Not a known
smoker or alcoholic
Conclusion
In the present scenario of alarming increased cancer incidence throughout the world; the proper treatment of ulcer or
protecting the skin from any damage or providing skin graft for the burs; may lead to a drop in the incidence of MU. Cancer which is
having the worst prognosis, difficult management, and increased chance of metastasis and relapse, had to be prevented. We wish to
emphasize the fact that, let us look at the ulcer or scar carefully and prevent the development of MU in the future. Let all our medical
fraternity joint together in the theme of preventable cancer, MU as sentinel type. We need further dedicated randomized control
studies regarding the same
... The term "Marjolin's ulcer" generally refers to squamous cell carcinoma arising from long standing scars or chronic non healing ulcers mostly arising from burn. However, wounds or scars other than burn, like scar of vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and ve-nous stasis may also induce this tumour [2,3,4]. The treatment of these lesions usually include wide local excision followed by reconstruction using different autologous tissues depending upon site, extent and patient related factors. ...
... This cutaneous malignancy most commonly arises from a long standing ulcer or scar due to burns. Whereas vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumour [2][3][4][5][6]. Metastasis in this disease has also been documented and once it does, prognosis worsens [7,9,11]. ...
Marjolin’s ulcer originate in long standing non healing ulcers of
various origin. It used to be the ulcerative variety of squamous
cell carcinoma, encountered on rare occasions. These lesions are
usually treated by wide local excision followed by reconstruction
preferably using vascularised tissue of similar nature. We came
across a young male patient with a large Marjolin’s ulcer over temporo-
parieto-occipital scalp extending intracranially with multiple
cardiac valve dysfunction. The ulcer was a malignant transformation
of a recurrent ulcerating scar resulting from thermal burn sustained
during early childhood. We experienced a turbulent episode
during excision of the pathology. The reconstruction was delayed
for 48 hours and achieved using free Latissimus dorsi muscle flap
covered with split thickness skin graft. This report emphasises the
importance of early diagnosis of this clinical entity, reconstructive
challenges for such extensive defects after its excision, anticipating
various possible fatal complications and preparedness of the
treating team to overcome them.
... The term "Marjolin's ulcer" generally refers to squamous cell carcinoma arising from long standing scars or chronic non healing ulcers mostly arising from burn. However, wounds or scars other than burn, like scar of vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and ve-nous stasis may also induce this tumour [2,3,4]. The treatment of these lesions usually include wide local excision followed by reconstruction using different autologous tissues depending upon site, extent and patient related factors. ...
... This cutaneous malignancy most commonly arises from a long standing ulcer or scar due to burns. Whereas vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumour [2][3][4][5][6]. Metastasis in this disease has also been documented and once it does, prognosis worsens [7,9,11]. ...
Marjolin’s ulcer originate in long standing non healing ulcers of various origin. It used to be the ulcerative variety of squamous cell carcinoma, encountered on rare occasions. These lesions are usually treated by wide local excision followed by reconstruction preferably using vascularised tissue of similar nature. We came across a young male patient with a large Marjolin’s ulcer over tem- poro-parieto-occipital scalp extending intracranially with multiple cardiac valve dysfunction. The ulcer was a malignant transforma- tion of a recurrent ulcerating scar resulting from thermal burn sus- tained during early childhood. We experienced a turbulent episode during excision of the pathology. The reconstruction was delayed for 48 hours and achieved using free Latissimus dorsi muscle flap covered with split thickness skin graft. This report emphasises the importance of early diagnosis of this clinical entity, reconstructive challenges for such extensive defects after its excision, anticipat- ing various possible fatal complications and preparedness of the treating team to overcome them.
... The term "Marjolin's ulcer" generally refers to squamous cell carcinoma arising from long standing scars or chronic non healing ulcers mostly arising from burn. However, wounds or scars other than burn, like scar of vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and ve-nous stasis may also induce this tumour [2,3,4]. The treatment of these lesions usually include wide local excision followed by reconstruction using different autologous tissues depending upon site, extent and patient related factors. ...
... This cutaneous malignancy most commonly arises from a long standing ulcer or scar due to burns. Whereas vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumour [2][3][4][5][6]. Metastasis in this disease has also been documented and once it does, prognosis worsens [7,9,11]. ...
... However, it is likely related to chronic irritation of the affected area. It has postulated that the release of toxins by autolysis and heterolysis of burn scar, prolonged healing phase, presence of exacerbated mitosis susceptible to mutations, poor lymphatic regeneration in scarring and displaced groups of epithelial cells induced pre-neoplastic cells mutation [18,19]. ...
Background: Epidermoid cysts are benign tumors that arise from the ectopic inclusion of epithelial cells and represent between 0.2 and 1.8% of all intracranial tumors. Those tumors seldom present in the frontal region or involve the frontal sinus. We report a giant extradural intradiploic epidermoid cyst invading the frontal sinus followed by a literature review to analyses a general profile of these cases. Case Description: A 23-year-old female with an intense left parietal headache with eye pain, diplopia and a frontal mass in left hemiface. At the examination, the patient had proptosis, divergent strabismus and altered gaze movement on upwards and medial positions of her left eye, and hypoesthesia on her left hemiface. The CT study of this lesion showed an expansive formation on her left frontal sinus with calcified borders invading the ethmoidal cell and the orbital roof, leading to proptosis and an impaired superior rectus muscle function. After microsurgery for tumor resection and cranial reconstruction, the histopathological study revealed findings compatible with an epidermoid cyst. Conclusion: To our knowledge, there are no significant guidelines for the management of intradiploic epidermoid cysts. This study suggests that in the analyzed cases, a surgical approach with total tumor resection often showed good results with only one case of tumor recurrence. Keywords: Epidermoid cyst, Frontal sinus, Diplopia, Systematic review
... The term was derived from observations during the first century by French surgeon Jean-Nicolas Marjolin [2]. In 1838, a study by Dupuytren observed that a Belgian man had cancer because of a scar that resulted from a sulfuric acid burn [3]. The name itself was published in 1850 by Robert Smith, who described it as cellular changes occurring in the ulcerated lesion of burn scar [4]. ...
... Marjolin's ulcer is somewhat preventable the same way by which wound degeneration can be prevented from transforming into malignant SCC. Providing early definitive wound coverage is a key principle for skin following burns or other trauma injuries [3]. Early skin grafting should be done for deep burn wounds, while early excision and grafting are recommended for all unstable scars that are susceptible to further trauma, such as scars located at the joint or other mobile regions [13]. ...
Marjolin’s ulcer is a rare malignancy found in nonhealing chronic wounds, with burn injury as the most common predisposing factor. It is an aggressive malignancy that has a long latency period, and it is diagnosed through clinical findings, histopathology, and imaging modalities. Prompt surgical treatment and proper burn wound care strategies are key to prevent further complications and increase in mortality.
... ere is commonly a delay between the initial tissue insult and the development of malignancy. is time period has been de ned as latency and ranges between 11 and 75 years [10]. However, there have been reports of "acute" Marjolin's ulcer occurring after months or even weeks [11]. Marjolin's ulcer is not an uncommon nding in the lower limbs but is vanishingly rare in the head and neck site. ...
... Marjolin's ulcer is not an uncommon nding in the lower limbs but is vanishingly rare in the head and neck site. Indeed, there is only one similar report in the literature of Marjolin's ulcer occurring in the postauricular region nine months after cortical mastoidectomy [11]. However, there are no reports of this pathology occurring in the pinna; hence, this would be a novel case. ...
Objective
To report a unique case of pinna squamous cell carcinoma (SCC) arising shortly after resection of atypical fibroxanthoma (AFX) at the same site.
Case report
An 81-year-old gentleman presented with a nodular right pinna lesion. This was excised, and histology confirmed AFX. Ten weeks later, an ulcerative lesion appeared at the resection site. This was confirmed to be SCC. Comparative analysis revealed no morphological resemblance between the initial AFX and new SCC lesion, and there was no evidence of initial misdiagnosis.
Conclusion
SCC is the most common cancer involving the pinna. Whilst prolonged sun exposure is an important risk factor for SCC, chronic inflammation and wounds are other potential sources. We postulate whether SCC could have arisen from the previous scar tissue in a manner similar to Marjolin's ulcer. This would be a highly unusual finding in the pinna and to our knowledge unprecedented in the English literature.
Marjolin's ulcer is a malignant neoplasm originating from long-standing or previously healed skin lesions. Well-differentiated squamous cell carcinoma (SCC) is the most common histologic type. It is an aggressive neoplasm with a poor prognosis and high recurrence rates. It predominates in men and has a higher incidence in the fifth decade of life. The diagnosis is histopathological. Surgical excision is the treatment of choice. Early diagnosis and prevention in wound management reduce complications and guide the correct therapeutic approach.
Chronic refractory wounds (commonly known as ulcers) can be formed by many reasons. The International Society for Wound Healing defines it as a wound that fails to achieve anatomical and functional integrity and secondary healing through a normal, orderly, and timely repair process. Clinically, it mostly refers to those who fail to heal and have no tendency to heal after more than one month of treatment. It depends on the wound size, the cause, the general health of the individual, and other factors. It mostly occurs in patients with severe chronic and acute injuries such as diabetes mellitus, trauma, varicose veins, angiosclerosis, paraplegia, and long-term bedridden. It has the characteristics of complicated pathogenesis, long course of disease, many disciplines involved, difficult treatment, and high treatment costs.
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 fourteen 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 21 st 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.
