Marjolin's ulcer

A Marjolin's ulcer (MU) is a cutaneous malignant transformation seen after long term inflammatory or traumatic insult to the skin.

• MU mostly arises in an area of chronic burn wounds. They are also seen in areas of chronic inflammation such as non-healing wounds, venous ulcers, lupus vulgaris, vaccination scars, snake bite scars, pressure sores, osteomyelitis zones, pilonidal abscess, and radiotherapy area
• the term Marjolin's ulcer (MU) has been used synonymously with burn scar carcinoma
• squamous cell carcinoma (SCC) is the most common cell type reported in MU
  • other cancers have also been observed as MU e.g. - basal cell carcinoma and malignant melanoma
• when compared to primary cutaneous cancers, they are more aggressive and have higher rates of local recurrence and metastasis (1,2)

The condition was first described in 1828 by the French surgeon Jean Nicolas Marjolin.

• he described the cellular changes of ulcerated lesions in scar tissue
• however a detailed description of the pathology was published by Robert Smith in 1850 and the condition was named “Marjolin’s ulcer” (1)

It is characterised by:

• slow growth - the scar is relatively avascular
• painless - the scar is devoid of nerve fibres
• absence of secondary deposits in regional lymph nodes - as the lymphatics have been destroyed. However, if the ulcer invades normal tissue surrounding the scar, it will advance at normal rates and most likely involve lymphatics

Reference:

• (1) Yu N et al. Marjolin's ulcer: a preventable malignancy arising from scars. World J Surg Oncol. 2013;11:313
• (2) Choa R, Rayatt S, Mahtani K. Marjolin's ulcer. BMJ. 2015 ;351:h3997.