Marjolin's ulcer on frostbite

Characteristics of Marjolin's Ulcers in 21st Century: A Retrospective Study, Systematic Review, and Surgical Guideline Recommendation

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.

Marjolin Ulcer: Clinical Experience with 34 Patients over 15 Years

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.

Cold injury

The pathophysiology of true frostbite reveals that the direct injury produced during the initial freeze process has a minor contribution to the global tissue damage. However, rapid rewarming to reverse the tissue crystallization has essentially been the lone frostbite intervention for almost half a century. The major pathologic process is the progressive microvascular thrombosis following reperfusion of the ischemic limb, with the cold-damaged endothelial cells playing a central role in the outcome of these frozen tissues. Newer interventions offer the opportunity to combat this process, and this article offers a scientific approach to frostbite injuries of the upper extremities.

Marjolin's ulcer revisited--basal cell carcinoma arising from grenade fragments? Case report and review of the literature

BACKGROUND

Marjolin's ulcer is a rare and often aggressive cutaneous malignancy arising in previously traumatized or chronically inflamed skin.

METHOD

CASE REPORT

A 79-year-old World War II veteran developed basal cell carcinoma (BCC) at the site of a war wound. The tumour developed in relation to several metal grenade fragments. With a disease-free interval of 61 years between injury and onset of complications the patient had one of the longest latency periods of tumour development described so far.

RESULTS

Review of the literature reveals only five cases of relation between grenade fragments and malignancy formation. Presence of foreign bodies has been described as possible aetiology for malignancy development. Explosives and additives contain several mutagenic and tumourigenic substances. We hypothesize a causal connection between the grenade fragments and the development of BCC. Considering the long period of latency between injury and tumour development we suggest grenade injury with left fragments in soft tissue to be a new origin of Marjolin's ulcer.