Clinicopathological Evaluation of Marjolin’s Ulcer: A Single Center Study
Author(s): Fahim EH, Rahman AKMS, Ahmed B, Karim SMR, Khondoker MS, Kalam MA
Marjolin's ulcer is an aggressive lesion that usually develops on chronic ulcers, scars, and osteomyelitis sinuses. This prospective observational study was conducted at the Department of Burn and Plastic Surgery, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh on 30 clinically suspected Marjolin’s ulcer patients who underwent excision biopsy for histopathology of the tissue from May 2015 to October 2016. Socio-demographic characteristics of the patients, aetiology of the lesions, sites involved, clinical presentation, latency period, dimensions of the ulcers, histopathological diagnosis, margin clearance, surgical procedures, and the outcome of management was recorded accordingly. In this study, the mean age of the suspected Marjolin’s ulcer cases was 40.47±14.42 years (ranging from 15 to 75 years), and male to female ratio was 2.3:1. The most predominant cause of primary insult was flame burn (82.67%) and only 13.33% was road traffic accident (RTA) cases. The ulcers were found on the extremities in almost all cases (29 out of 30), and the lower limbs were the most predominant sites (19 out of 30). The most frequently observed clinical findings were cutaneous ulcers within the scars (70%), followed by foul-smelling discharge (53.33%) and bleeding from the ulcer sites (26.67%). The mean latency period was 19.5±4.26 years (ranging from 3 to 50 years and 11 months). The mean length of the ulcers was 5.67±3.12 cm and the mean width was 3.47±1.87 cm. According to the histopathology report, 77% of the resected tissues were diagnosed as malignant cases; mostly (63.34%), squamous cell carcinoma (SCC) of different grades, and 17% were benign cases (Chronic non-healing ulcer). Most of the cases (80%) underwent split-thickness skin grafting (STSG), five patients (16.67%) underwent different types of flaps coverage, and amputation followed by direct closure of the wound was done on one patient (3.33%). The outcome of the treatment was good in most of the cases. This study concluded that Marjolin’s ulcer is frequent in middle-aged males with long-standing scar ulcers, develops usually on the extremities, the predominant primary cause of the wounds is flame burn, and in most cases, it is squamous cell carcinoma (SCC) of different grades.