Current concepts in the management of Marjolin's ulcers: outcomes from a standardized treatment protocol in 16 cases.

Marjolin's ulcer is a malignant lesion observed in chronic wounds and in areas where the integrity of the skin is compromised because of any one of several reasons. The aim of this study was to define etiology, topography, and histopathology for Marjolin's ulcer and its surgical management. Sixteen cases were diagnosed and treated as Marjolin's ulcers. The mean age was 57.1 years (range, 32-85 years) and 15 of the patients (93.75%) had history of ulcer of 30 years or more. In 10 cases (62.5%), Marjolin's ulcer occurred after a flame burn and in 6 cases (37.5%) after a scalding burn injury. In six cases (37.5%), there was history of chronic trauma due to contact with the clothing. Primary lesions were at the leg, gluteal region, thigh, scalp, trunk, and hand in four (25%), three (18.7%), two (12.5%), two (12.5%), three (18.7%), and two (12.5%) cases, respectively. Amputation was carried out to treat two cases, and repair of the defects with partial-thickness skin grafting was performed in 14 cases after tumor resection on the skin. Superficial inguinal lymph node dissections were performed in four cases with tumor in the thigh and a positive inguinal lymph node. Squamous cell carcinoma was diagnosed in 14 cases (87.5%) and basal cell carcinoma in two cases (12.5%) postoperatively. The authors conclude that diagnosis and surgical planning based on the recent literature must be carried out even more intensively to improve the prognosis of Marjolin's ulcer.