Marjolin’s Ulcer: A Complication of Chronic Ulcers and Scars in A University Teaching Hospital in Southern Nigeria

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Marjolin’s Ulcer: A Complication of Chronic Ulcers and Scars in A University Teaching Hospital in Southern Nigeria

Journal Title: Saudi Journal of Medicine - Year 2017, Vol 2, Issue 4

Abstract

Abstract: Marjolin’s ulcer (MU) represents malignant degeneration or transformation that typically occurs over a period of time in chronic ulcers, post-burned lesions and scars. It is a rare occurrence but a serious complication of chronic ulcers and scars. The aim of this study was to evaluate the epidemiology, clinico-pathological pattern, treatment outcome of patients with Marjolin’s ulcer in a Teaching Hospital in Southern Nigeria. We evaluated patients who presented with ulcers resulting from chronic wounds, post- burned lesions and scars who had histologically proven skin cancers between January, 2013 and 2015 .All chronic ulcers lasting more than 6 months with clinical evidence of malignancy were biopsied for histology. The patients ’case notes and cancer register were also assessed. Patients with negative biopsy results for malignancy were excluded in the study. A total of 13 patients were diagnosed Marjolin’s ulcer within 3 years of the study period. 10 patients were males while three were females with age range of 24 to 72years, the mean was 38years, and peak age was 36- 42 years. Squamous cell carcinoma was the leading cause constituting 9(69.2%), baso-squamous carcinoma 3(23.1%) followed by basal cell carcinoma 1(7.7%). Aetiologically, trauma is the leading cause making up of 10 (76.9%) and followed up by post-burned injuries 3 (23.1%). The commonest site of lesions were the lower limbs 9(69.2%), the upper limb 2(15.4%), the head/neck 1(7.7%) and the trunk 1(7.7%). The tumour types were exophytic 5(38.5%) while the infiltrative type was 8(61.5%). The tumour size less than 5cm were 4(30.8%) while size greater than 5cm 9(69.2%). The most common reason for late presentation was poverty and treatment by traditional healers. Surgical resection with skin graft or flap was the main modality of treatment followed by radiotherapy and chemotherapy. Two patients had amputation of the limbs because of bony involvement. In conclusion, Marjolin’s ulcer is a malignant degeneration of chronic ulcers and scars. Late presentation is a common feature. Delayed presentation was mainly due to economic problems and treatment by traditional healers. Therefore, health education and early closure of wounds would help to prevent the development of marjolin’s ulcers among our patients. Keywords: Marjolin’s ulcer, squamous cell carcinoma. Chronic ulcers, post-burned scars, malignant degeneration

Authors and Affiliations

Ozinko M. O, Otei O. O, Ekpo R. G, Isiwele E

Keywords

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