Marjolin Ulcer

The strict definition of a Marjolin ulcer is a carcinoma that transforms from the chronic open wound of a pressure sore or burn scar. It is now used to describe any carcinoma arising from chronic wounds.

Average latency between ulcer formation and documentation of a malignancy is 30 years; however, intervals as short as 18 months have been reported. Between 1 - 2 % of chronic wounds develop malignant degeneration. The risk of developing malignancy in a venous ulcer is higher (about 20%).

These lesions behave aggressively and have a propensity for local recurrence and lymph node metastases.

The typical presentation is a 40- to 70-year-old man with osteomyelitis and a chronic lower extremity wound, who develops squamous cell carcinoma in the draining sinus tract ("warty tumors in cicatrices").

The image above is from a 50-year-old man with a chronic wound on his shin, with a small plaque that appeared about 1 year ago and has increased in size over the last 2-3 months. Biopsy showed squamous cell carcinoma.

Pyogenic granuloma can have a similar appearance on imaging, but is more common on the hands and feet, has a faster onset after injury/wound formation, and has a typical appearance on physical examination.

References

• Gilmore A, Kelsberg G, Safranek S. Clinical inquiries. What's the best treatment for pyogenic granuloma? J Fam Pract. 2010 Jan;59(1):40-2.
• Quitkin HM, Rosenwasser MP, Strauch RJ. The efficacy of silver nitrate cauterization for pyogenic granuloma of the hand. J Hand Surg Am. 2003 May;28(3):435-8.
• Zaballos P, Llambrich A, Cuéllar F, Puig S, Malvehy J. Dermoscopic findings in pyogenic granuloma. Br J Dermatol. 2006 Jun;154(6):1108-11.
• Trent JT, Kirsner RS. Wounds and malignancy. Adv Skin Wound Care. 2003 Jan-Feb;16(1):31-4.