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      Marjolin’s ulcer in chronic wounds – review of available literature

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          Abstract

          Marjolin’s ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. Its incidence is estimated to range from 1% to 2% of all burn scars. It most frequently takes the form of squamous cell carcinoma which sometimes is diagnosed during examination of lesions developing in scars and hard-to-heal chronic wounds (pressure sores, leg ulcers). Therapeutic management of Marjolin’s ulcer requires well-designed treatment plan to ensure optimal medical care and good quality of life for the patient. The high risk of metastases and damage to the structure of vitally important organs determines the need for early diagnosis and prompt surgical intervention with supplementary therapy.

          The purpose of the study was to examine etiopathogenesis of Marjolin’s ulcer and principles of its treatment. The authors focused on the aspect of malignant degeneration in chronic wounds (leg ulcers, pressure sores) as a very rare, aggressive form of Marjolin’s ulcer. A review of the available literature on the issue of Marjolin ulcers was conducted using the key words; Marjolin ulcers, pressure sore, chronic wound. Malignant degeneration in chronic wounds is a very rare aggressive form of Marjolin ulcer.

          Increased oncological alertness should be displayed by nursing and medical personnel taking care of patients with chronic wounds.

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          Most cited references47

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          Burn scar neoplasms: a literature review and statistical analysis.

          Although squamous cell carcinoma (SCC) is the most common burn scar neoplasm, other neoplasms have also been reported. To compile the burn scar neoplasm cases in the literature and to analyze their frequency and demographic characteristics. Cases were obtained through literature searches. There were 412 cases gleaned from 146 articles between 1923 and 2004. Seventy-one percent (293) of the tumors were squamous cell carcinoma, 12% (48) were basal cell carcinoma (BCC), 6% (23) were melanoma, 5% (21) were sarcoma, 4% (16) were other neoplasms, 1% (6) were squamo-basal cell carcinoma, and 1% (5) squamous cell-melanoma. The mean age at tumor diagnosis was 50 years, the mean age at the time of burn injury was 20 years, the mean latency interval was 31 years. Only 5% of the reported cases were excised and grafted at the time of injury (p<0.001). BCC occurred at a significantly later age compared to SCC and sarcoma groups (p<0.02) and had a shorter latency period compared to SCC and sarcoma groups (p<0.004) and melanoma (p<0.008). Local recurrence was present in 16% of the cases, while regional lymph node involvement was seen in 22% of the cases and distant metastases was present in 14% of the patients. The mortality rate was 21%. Although the main burn scar neoplasm was SCC, other neoplasms contributed to the morbidity and mortality of burn patients. Excision and grafting of deep burns, and close follow-up of non-healing ulcerated burn scars is essential for the prevention and early detection of burn scar neoplasms.
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            Marjolin's ulcer: modern analysis of an ancient problem.

            Marjolin's ulcer is a rare but highly aggressive squamous cell cancer that is most often associated with chronic burn wounds. Although many individual case reports exist, no thorough evaluation of Marjolin's ulcer patients has been conducted to date. The authors present their experience with 10 patients encountered over a period of 15 years and analyze 25 previous publications, for a total of 443 patients diagnosed with Marjolin's ulcer. Although burn scar represents 76.5 percent of patients in the authors' review, venous stasis ulcers, traumatic wounds, osteomyelitis, and pressure sores are also represented as wound types that can undergo malignant degeneration. The authors' review suggests that there is much variability in the anatomical location of Marjolin's ulcers, with the majority occurring in wounds of the upper and lower extremities. Marjolin's ulcer appears to be preventable if early wound coverage is undertaken. Countries with limited access to medical treatment report a high number of Marjolin's ulcers compared with more developed regions.
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              Wounds and malignancy.

              Due to the prevalence of skin cancers, health care practitioners involved with wound management are likely to encounter cutaneous malignancies as part of their practice. This article focuses on 2 ways in which malignancies and wounds are related: the malignant degeneration of chronic wounds into cancer and malignancies that present as chronic wounds. The most common scenario in which chronic wounds have been associated with the development of squamous cell carcinoma is in the presence of chronic osteomyelitis. However, wounds secondary to burns, trauma, radiotherapy, and diabetes are also at risk for malignant degeneration. It is often difficult to distinguish malignant transformations from primary malignant ulcers. Given the uncommon nature of degeneration of a chronic wound or a malignancy presenting as a chronic wound, some suggest that only suspicious wounds undergo biopsy. Primary malignancy should be considered if the ulcer has a relatively short duration and the patient does not have a history of prior radiotherapy. Until recently, amputation has been the treatment of choice for squamous cell carcinomas that arose within chronic wounds associated with chronic osteomyelitis; however, other reports have shown that other methods of ensuring complete local excision are also useful.
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                Author and article information

                Journal
                Contemp Oncol (Pozn)
                Contemp Oncol (Pozn)
                WO
                Contemporary Oncology
                Termedia Publishing House
                1428-2526
                1897-4309
                29 September 2017
                2017
                : 21
                : 3
                : 197-202
                Affiliations
                [0001]1Institute of Nursing and Health Sciences, Medical Faculty, University of Rzeszow, Rzeszów, Poland
                [2 ]Podkarpackie Oncology Centre Specialist Hospital, Brzozów, Poland
                [3 ]Postgraduate Nursing and Midwifery Education Centre, Rzeszów, Poland
                [4 ]Podkarpackie Oncology Centre Specialist Hospital, Brzozów, Poland
                Author notes
                Address for correspondence: Paweł Więch, Institute of Nursing and Health Sciences, Medical Faculty, University of Rzeszow, mjr. W. Kopisto 2 A, 35-310 Rzeszów, Poland. e-mail: p.k.wiech@ 123456gmail.com
                Article
                30590
                10.5114/wo.2017.70109
                5701580
                29180925
                078e6207-df3a-4d38-9187-db0edc77299a
                Copyright: © 2017 Termedia Sp. z o. o.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                : 28 November 2016
                : 20 February 2017
                Categories
                Review Paper

                marjolin’s ulcer,chronic wounds,diagnosis,treatment
                marjolin’s ulcer, chronic wounds, diagnosis, treatment

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