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© Borgis - New Medicine 4/2014, s. 139-141
*Konrad Wroński1,2
Marjolin’s ulcer of the thigh after burn injury – case report and review of literature
1Department of Oncology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Head of Department: prof. Sergiusz Nawrocki, MD, PhD
2Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Head of Department: Andrzej Lachowski, MD
Summary
Marjolin’s ulcer is defined as a tumor which is arising from a chronic wound, scar or chronic inflammation. It is a rare chronic cutaneous ulcer which is often malignancy. The majority of malignancy in Marjolin’s ucers are squamous cell carcinomas. Rarely described malignancies in Marjolin’s ulcers are basal cell carcinoma, melanoma, adenocarcinoma, liposarcoma, fibrosarcoma and osteogenic sarcoma.
The author of this article present a case of a 70-year-old Caucasian man who was admitted to the hospital because of Marjolin’s ulcer. The author performed a literature review on Marjolin’s ulcer diagnosis and treatment.



INTRODUCTION
Marjolin’s ulcer is defined as a tumor which is arising from a chronic wound, scar or chronic inflammation (1, 2). It is a rare chronic cutaneous ulcer which is often malignancy (1, 2). The majority of malignancy in Marjolin’s ucers are squamous cell carcinomas. Rarely described malignancies in Marjolin’s ulcers are basal cell carcinoma, melanoma, adenocarcinoma, liposarcoma, fibrosarcoma and osteogenic sarcoma (3).
CASE REPORT
A 70-year-old Caucasian man was referred to the Department of Surgical Oncology Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre in Olsztyn due to Marjolin’s ulcer of the right tight (fig. 1). In an interview with the patient, he had the burn injury 15 years ago and from 3 years he observed tumor which was arising from this chronic wound. Marjolin’s ulcer in histopathologically examination was: squamous cell carcinoma G2. CT scan showed no infiltration carcinoma cells on important important nerve or vascular structures or bone. The patient had no any other symptoms, there was no history of weight loss and loss of appetite. The patient was treated chronically for hypertension and benign prostatic hyperplasia (BPH). He had no surgeries and there was no history of carcinoma in patient family. Blood test and other routine hematological examinations and biochemical tests were within normal limits.
Figure 1. Clinical photograph of Marjolin’s ulcer on the right tight from burn injury.
The chronic wound after burn injury had diameter 20 centimeters. In the central part of this wound was located Marjolin’s ulcer diameter 11 centimeters (fig. 2). Regional lymph nodes in palpable examination were not enlarged.
Figure 2. The chronic wound on the right tight had diameter 20 centimeters and in the central part of chronic wound was located Marjolin’s ulcer diameter 11 centimeters.
The patient was admitted to the Department of Surgical Oncology to wide local excision of Marjolin’s ulcer. The patient was informed about the possibility of treating Marjolin’s ulcer and possible complications associated with surgery. The patient refused surgery and decided that he wanted to undergo radiotherapy treatment. The patient was transferred for further treatment to the Department of Radiotherapy Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre in Olsztyn.
DISCUSSION

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Piśmiennictwo
1. Agale SV, Kulkarni DR, Valand AG et al.: Marjolin’s Ulcer – a diagnostic dilemma. JAPI 2009; 57: 593-594. 2. Suhag V, Sunita, Singh S, Nimbrian VK et al.: Marjolin’s ulcer developing in electric burns: a rare case report. Pak J Med Sci 2005; 21(3): 375-376. 3. Hill BB, Sloan DA, Lee EY et al.: Marjolin’s ulcer of the foot caused by nonburn trauma. South Med J 1996; 89(7): 707-710. 4. Marjolin NJ: Ulcere. Dictionnaire de medicine 1828; 21: 31. 5. Treves N, Pack GT: The development of cancer in burn scars. Surg Gynecol Obstet 1930; 51: 749-782. 6. DaCosta JC: Carcinomatous changes in an area of chronic ulceration, or Marjolin’s ulcer. Ann Surg 1903; 37: 495-502. 7. Nthumba PM: Marjolin’s ulcers: theories, prognostic factorsand their peculiarities in spina bifida patients. World J Surg Oncol 2010; 8: 108. 8. Chintamani M, Shankar M, Singhal V et al.: Squamous cell carcinoma developing in the scar of Fournier’s gangrene – case report. BMC Cancer 2004; 274(1): 16. 9. Calikapan GT, Akan M, Karaca M et al.: Marjolin ulcer of the scalp: report of 5 cases and review of the literature. J Craniofac Surg 2008; 19: 1020-1025. 10. Wysocki WM, Komorowski A, Wojewoda T et al.: Two different cases of Marjolin’s ulcer and recommendations for practice. TOSJ 2010; 2: 83-85. 11. Davalos BA, Cortes-Flores AO, Bandera-Delago A: Malignant neoplasm in burn scar: Marjolin’s ulcer: report of two cases and review of the literature. Cir Cir 2008; 76: 329-331. 12. Ozek C, Celik N, Bilkay U et al.: Marjolin’s ulcer of the scalp: report of 5 cases and review of the literature. J Burn Care Rehabil 2001; 22: 65-69. 13. Malheiro E, Pinto A, Choupina M: Marjolin’s ulcer of the scalp: case report and literature review. Ann Burns Fire Disasters 2001; 14: 39-41. 14. Tutela RR Jr, Granick M, Benevenia J: Marjolin’s ulcer arising in pressure ulcer. Adv Skin Wound Care 2004; 17: 462-467. 15. Kowal-Vern A, Criswell BK: Burn scar neoplasms: a literature review and statistical analysis. Burns 2005; 31: 403-413. 16. Ochenduszkiewicz U, Matkowski R, Szynglarewicz B et al.: Marjolin’s ulcer: malignant neoplasm arising in scars. Rep Pract Oncol Radiother 2006; 11(3): 135-138. 17. Lack W, McKinley T.: Marjolin’s ulcer: incidental diagnosis of squamous cell carcinoma on hemipelvectomy for recalcitrant pelvic osteomyelitis. IOWA Orthop J 2010; 30: 174-176. 18. Nthumba PM.: Marjolin’s ulcer in sub-Sahara Africa. World J Surg 2010; 34: 2272-2277.
otrzymano: 2014-10-08
zaakceptowano do druku: 2014-11-18

Adres do korespondencji:
*Konrad Wroński
General Surgery Consultant
Department of Surgical Oncology
Faculty of Medicine University of Warmia and Mazury
37 al. Wojska Polskiego, 10-228 Olsztyn, Poland
tel.: +48 505-818-126
e-mail: konradwronski@wp.pl

New Medicine 4/2014
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