Marjolin's ulcer
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Marjolin's ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatised [1], chronically inflamed [2], or scarred skin [3]. They are commonly present in the context of chronic wounds including burn injuries, venous ulcers, ulcers from osteomyelitis [4], and post radiotherapy scars.
The term was named after French surgeon, Jean Nicolas Marjolin, who first described the condition in 1828. The term was later coined by J C De Costa.
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[edit] Appearance
Marjolin's ulcer presents as a raised, firm, pink-to-flesh-colored papule or plaque arising in a chronic site of inflammation or scar. It is characterized by slow growth, painlessness (as the ulcer is usually not associated with nerve tissue), and absence of lymphatic spread due to local destruction of lymphatic channels [5].
[edit] Characteristics
Histologically, the tumour is a well-differentiated squamous cell carcinoma. This carcinoma is aggressive in nature, spreads locally and is associated with a poor prognosis[6].
[edit] Diagnosis
Biopsy is favored method of diagnosis. Tissue specimens obtained should be taken from both the centre and margin of lesion, as the central ulcerated deposits may be necrotic.
[edit] Treatment
Treatment is usually surgical, with a wide excision of the lesion; typically a 1 cm margin all around is required.
[edit] References
- ^ Esther RJ, Lamps L, Schwartz HS. Marjolin ulcers: secondary carcinomas in chronic wounds. J South Orthop Assoc. 1999 Fall;8(3):181-7.
- ^ Simmons MA, Edwards JM, Nigam A. Marjolin's ulcer presenting in the neck. J Laryngol Otol. 2000 Dec;114(12):980-2.
- ^ Phillips TJ, Salman SM, Bhawan J, Rogers GS. Burn scar carcinoma. Diagnosis and management. Dermatol Surg. 1998 May;24(5):561-5.
- ^ Smidt LS, Smidt LF, Chedid MB, Bavaresco CS, Chedid MF. Radical surgical treatment for Marjolin ulcer occurring after chronic osteomyelitis South Med J. 2005 Oct;98(10):1053.
- ^ Paredes F. Marjolin ulcer. Acta Med Port. 1998 Feb;11(2):185-7.
- ^ Chong AJ and MB Klein. Marjolin's ulcer. New England Journal of Medicine 2005 Mar; 352(1):e9
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