Marjolin’s ulcers in the post-burned lesions and scars

Abstract

Marjolin’s ulcer (MU) represents malignant degeneration that typically ensues over a period of time in the post-burned lesions and scars or any other chronic wound. This review highlights various facets of the presentation and management of MUs that originate from post-burned lesions. The incidence of MUs in such lesions is reported to be 0.77%-2%. This malignancy characteristically develops in the areas of full thickness skin burns that had been allowed for weeks to months to heal spontaneously by secondary intention, or burn wounds which never healed completely over years and the unstable post-burned scars. In the majority of cases, the MU is a squamous cell carcinoma (SCC). The MUs contribute to an overall 2% of all SCCs and 0.03% of all basal cell carcinomas of the skin. Clinically MUs present in two major morphologic forms. The commoner form is the flat, indurated, ulcerative variety while the less common form is the exophytic papillary variety. Lower limbs represent the most frequently affected body parts. Surgical resection of the primary tumor with 2-4 cm horizontal clearance margin, nodal clearance and radiotherapy constitute the cornerstones of effective oncologic management. Despite best efforts, the overall mortality is reported to be 21%.

Keywords: Marjolin’s ulcer, Malignant degeneration, Post-burned scars and wounds, Sentinel lymph node dissection, Squamous cell carcinoma, Full thickness skin burns, Healing by secondary intention

Core tip: This review on Marjolin’s ulcer (MU) provides a comprehensive account of the key conceptual issues, historic background as well as recent updates on the management of MU developing in the post-burned lesions and scars. New concepts in the management in general and the evolving concepts in the prophylactic nodal treatment such as the sentinel lymph node mapping are highlighted. The epidemiologic and pathophysiologic factors that surround the development of MU in the post-burned lesions are described in vertical depth with subsequent emphasis on the preventive aspects, which certainly hold the key to eradication of this dreadful menace.