Marjolin's ulcer



Marjolin's ulcer refers to an aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatised, chronically inflamed , or scarred skin. They are commonly present in the context of chronic wounds including burn injuries, venous ulcers, ulcers from osteomyelitis, and post radiotherapy scars.

The term was named after French surgeon, Jean Nicolas Marjolin, who first described the condition in 1828. The term was later coined by J C De Costa.

Appearance
Marjolin's ulcer presents as a raised, firm, pink-to-flesh-colored papule or plaque arising in a chronic site of inflammation or scar. It is characterized by slow growth, painlessness (as the ulcer is usually not associated with nerve tissue), and absence of lymphatic spread due to local destruction of lymphatic channels.

Characteristics
Histologically, the tumour is a well-differentiated squamous cell carcinoma. This carcinoma is aggressive in nature, spreads locally and is associated with a poor prognosis.

Diagnosis
Biopsy is favored method of diagnosis. Tissue specimens obtained should be taken from both the centre and margin of lesion, as the central ulcerated deposits may be necrotic.

Treatment
Treatment is usually surgical, with a wide excision of the lesion; typically a 1 cm margin all around is required.