2025 Volume 51 Issue 3 Pages 97-104
Objective: Marjolin’s ulcers typically present as well-differentiated squamous cell carcinomas（SCC）; however, they have a worse prognosis than other SCCs. We clinically analyzed cases of Marjolin’s ulcers encountered in our department.
Methods: We reviewed 18 patients diagnosed with Marjolin’s ulcers in our department over a 10-year period（2014 to 2023）. We examined the following parameters: age, sex, site of occurrence, predisposing lesion, duration from initial lesion to carcinogenesis, clinical stage, treatment, pathological diagnosis, presence of lymph node metastasis, and prognosis.
Results: The mean age of patients was 72.4 years, with a male-to-female ratio of 13:5. The primary sites were the lower limbs (6 cases), upper limbs (5 cases), head (4 cases) , buttocks (2 cases), and back (1 case), with a predominance in the extremities. The predisposing lesions were burn scars (8 cases), traumatic scars (5 cases), inflammatory skin diseases (3 cases), and chronic ulcers (2 cases) . The latency period from initial lesion to carcinogenesis ranged from 6 to 77 years, with an average of 54.1 years. The clinical stages were stage I (2 cases), stage II (7 cases), stage III (8 cases), and stage IV (1 case). Excision was performed with a margin of at least 1 cm in all cases except for one case with a 6-mm margin. Sixteen patients underwent sentinel lymph node biopsy, whereas two patients declined the procedure. All amputation cases underwent primary wound closure. All other reconstructions were performed as secondary procedures. Histopathological diagnosis revealed SCC in all cases: well-differentiated（10 cases）, well-to-moderately differentiated（4 cases）, moderately differentiated（3 cases）, and poorly differentiated（1 case）. Lymph node metastasis was observed in four cases, all of which originated from traumatic scars. Regarding prognosis, 11 patients achieved disease-free survival, four experienced recurrence, one developed distant metastasis and died, and two had an unknown prognosis.
Conclusion: Compared with conventional SCC, the recurrence rate and lymph node metastasis rate of Marjolin’s ulcers were higher. However, in comparison with previous reports on Marjolin’s ulcers, the prognosis was favorable, with no cases of recurrence, metastasis, or death observed in burn scar-associated cases. This favorable outcome may be attributed to early biopsy and definitive diagnosis, ensuring excision with a margin of at least 1 cm including the scar, universal application of sentinel lymph node biopsy, and secondary reconstruction for non-amputation cases.
