Historically, Marjolin ulcer is named after a French surgeon Jean-Nicolas Marjolin. Burns, scars are the most common triggers that lead to the development of this condition.
Other chronic inflammatory conditions that can cause Marjolin ulcers are traumatic wounds, osteomyelitis, venous stasis ulcers, pressure ulcers, stings, bites, radiation dermatitis, and hidradenitis suppurativa
What is a Marjolin ulcer?
A Marjolin ulcer is an aggressive type of skin cancer that mostly arise from the area of chronic injury (burn scars) or inflammation and develop over many years. It grows gradually, then over time, it can spread to other parts of the body such as the brain, lungs, liver, or kidneys.
Marjolin ulcers can affect people of all ages, races, and sexes. Men are usually affected than women. They are common in people who live in developing countries because of lack of access to proper wound care centers. Marjolin ulcer affects people over the age of 50 more and are common in the leg, feet, and sometimes on the head and neck.
In the early stages, the affected area of your skin will itch, burn, and blister. After which, a new open sore that is filled with some hard lumps will be formed around the damaged area. They are usually flat with raised edges.
Often, this ulcer can close and then reopen and may continue to grow after the first sore forms. A person may notice one of the following after the sore forms;
- severe pain
- foul-smelling pus
How does Marjolin Ulcer Develop?
It’s estimated that about 2 to 5 percent of burn scars result in Marjolin ulcers. It is developed from damaged skin usually an area of the skin that’s been burned.
Marjolin ulcers can also develop from one of the following;
- bone infections
- lupus scars
- open sores caused by venous insufficiency
- vaccination scars
- amputation stumps
- radiation-treated areas of skin
Even though no study has been able to know the reason why the damaged skin area turns cancerous. Nevertheless, there are 2 theories:
- The burns the injury destroys lymphatic vessels and blood vessels of your body which makes it harder for your skin to combat cancer
- Since prolonged irritation can cause skin cells to repair themselves, some skin cells can become cancerous during the process of repair.
How is Marjolin Ulcer Diagnosed?
They grow very slowly, so it usually takes a long time to turn into cancer usually takes up to 35 years, and in rare cases may take about 75 years to develop. Marjolin ulcer is a severe condition whereby only 40% to 69% of people that has it are alive after 5-years of being diagnosed.
So if an individual has a burn scar that hasn’t healed after 3 months, they should be referred to a dermatologist to examine their skin.
So if the dermatologist notices that the scar or sore could be cancerous, the dermatologist will likely perform a Biopsy. They will take a small sample of cells or tissues from the wound for examination. Your doctor might also carry out an MRI scan or a CT scan to ensure it hasn’t spread to other organs or your bones.
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How is Marjolin Ulcer Treated?
The treatment for this cancer usually involves Surgical procedure to remove the tumor. Your surgeons can either use one of these methods:
- Mohs Surgery: This type of surgery has different stages
Your skin layer is removed by your surgeon and looked under a microscope will you wait. This procedure is repeated many times until no more cancer cells are left
- Excision: This process involves surgical removal (cutting out) of the tumor and also some of the tissue around it.
If the cancer has gone to nearby areas of the body, the affected person may require one of this:
- radiation therapy
Note: After Surgery, the person will need a skin graft; where a piece of healthy skin from part of their body is cut out and transplanted to cover the area where the tumor was cut out from.
Are they preventable?
Ensure you take proper care, and if possible, get emergency medical treatment if you should have severed burn or a large open wound. It will help to reduce the risk of developing this condition or severe infection.
Also, consult your doctor if you have any burns or sores that don’t seem to be healing after 3 weeks. Call your doctor immediately if you have old burn scar that has developed a lesion.
Marjolin ulcer is a severe condition and can cause death. Marjolin ulcer can come back even after they have been removed. Ensure you regularly follow up with your doctor, and if you notice any changes around the affected area, please tell them.
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Junaid F, et al. (2017). Marjolin ulcer.