Clinical presentation of two patients with Marjolin’s ulcer presenting in an area of previously burned skin: A case report

Abstract

Background: Marjolin's ulcer (MU) refers to an aggressive ulcerating squamous cell carcinoma (SCC) presenting in an area of previously traumatized, chronically inflamed, or scarred skin. They usually develop in the areas of full thickness skin burns that had been allowed for weeks to months to heal spontaneously by secondary intention or burn wounds which never healed completely over years and the unstable post-burned scars. Lower limbs represent the most frequently affected body parts. Treatment is usually surgical, with a wide excision of the lesion; typically, a 2-5 cm margin all around is required. Despite best efforts, the overall mortality is reported to be 21%. The aim of this case report was to present two of our patients suffering from mistreated and misdiagnosed Marjolin’s ulcer, and to evaluate clinical presentation, diagnostic and therapeutic difficulties in this rare condition. Treatment of both patients was surgical and radical, whereas in the first patient, high femoral amputation with the stump reconstruction was performed. In the second patient, after a radical excision in sano and an extirpation of supraclavicular lymph nodes, a defect was reconstructed with rotational tubular miocutaneous latissimus dorsi flap. Conclusion: Reconstructive surgery provided a dramatic cosmetic improvement with significant psychosocial benefit. Unfortunately, high-grade tumours have significantly high amount of recurrence and positive lymph node metastases, so repeated surgical procedures may be required.