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What Is a Marjolin Ulcer?

Medically Reviewed by Dan Brennan, MD on April 12, 2021

A Marjolin ulcer is an aggressive and rare type of skin cancer that grows from burns, poorly healing wounds, or scars. It grows slowly, but over time it can spread to other parts of your body, including your brain, kidneys, liver, or lungs.

What Are the Signs of a Marjolin Ulcer?

Some of the first signs of a marjolin ulcer are irritation and damage around an injured area. Your skin will likely itch, burn, and blister. Soon after, a new open sore will appear, filled with several hard lumps around the injured area. It looks like a flat ulcer with edges that are raised, in most cases.

As the sore forms, it’s also common to experience bleeding, crusting, foul-smelling pus, and severe pain. Marjolin ulcers can close and reopen repeatedly. They also may continue to grow after the formation of the initial sore.

Research also suggests that Marjolin ulcers are most likely to grow on your legs, feet, neck, and head.

Most Marjolin ulcers are cancerous and form squamous cancer cells in the upper layers of your skin. Some Marjolin ulcers may also form as basal cell tumors which form in deeper layers of your skin.  

Who Is at Risk for a Marjolin Ulcer?

‌According to existing research, a Marjolin ulcer is three times more likely to develop in men. People who are 50 years of age or older, living in developing countries and having little access to medical care, are also more likely to be at risk.

How Does a Marjolin Ulcer Develop?

Marjolin ulcers come from previously hurt, traumatized, and chronically inflamed skin or scar tissue. They are commonly associated with burn scars but may also result from.

Pressure sores. These are areas of damaged skin. The damage is caused by staying in one position for too long. Pressure sores usually occur when you are bedridden or unable to move. They typically form where your bones are close to your skin, such as your ankles, elbows, heels, hips, and back.

Chronic venous ulcers. These are long-lasting sores that develop on the inside of your leg, causing pain, itching, and swelling.

Wounds. Wounds are any kind of damage or break in the surface of your skin.

Osteomyelitis. This is an inflammation of your bones caused by infections, generally in the legs, arm, or spine. Infections can reach your bones by traveling through your bloodstream or spreading from nearby tissue.

Fistulas. These are abnormal connections between two body parts, such as an organ or blood vessel and another structure. Fistulas are usually the result of an injury or surgery.

Leprosy ulcers. These ulcers are infections caused by slow-growing bacteria called Mycobacterium leprae. They can affect your nerves, skin, eyes, and lining of the nose.

Amputation stumps. After a limb is removed, the part that's left beyond a healthy joint is called a residual limb, or more commonly, a stump.

Skin grafts. A skin graft is where healthy skin is removed from an unaffected area of your body and used to cover lost or damaged skin.    

Radiation-treated areas of skin. Radiation is a type of cancer treatment that uses beams of intense energy to kill cancer cells.

Scars. Scars are areas of tissue growth that mark a spot where your skin has healed after an injury.  

How Is a Marjolin Ulcer Diagnosed?

To diagnose a Marjolin ulcer, a doctor will likely start by asking you about your medical history and the causes of any wounds that you may have.

They may also take a biopsy of your damaged skin. Parts of your damaged skin will be removed and sent off to a lab for evaluation.   

If a lab confirms that you have a Marjolin ulcer, the next step is to see how much cancer is in your body. This may be done through an exam by your doctor or with an MRI or CT scan.

How Is a Marjolin Ulcer Treated?

A common treatment for a Marjolin Ulcer is Mohs surgery, which is done to remove the cancer. The surgery is done in several stages. Your doctor will remove a layer of your skin, look at the layer under a microscope, and then keep repeating the process until there are no longer any cancer cells.    

After the surgery, your doctor may recommend covering the area of damaged skin with a skin graft. Your doctor may also prescribe other treatments, including.     

Chemotherapy. Chemotherapy is a drug treatment that uses powerful chemicals to kill fast-growing cells in your body.   

Radiation therapy. In radiation therapy, beams of intense energy are used to kill cancer cells. 

Amputation. Amputation is the removal of a limb by trauma, medical illness, or surgery.   

After surgery and any other treatments, you should follow up with your doctor regularly to ensure that the cancer hasn't returned.  

What Is the Prognosis of a Marjolin Ulcer?

Marjolin ulcers are severe and, in some cases, may lead to death. Your prognosis depends on how aggressive your cancer is and how much it has spread. The five-year survival rate for a Marjolin ulcer is typically 40%-69%.  ‌

This five-year survival rate means that 40%-69% of people with a Marjolin ulcer remain alive five years after diagnosis.  

It’s important to keep in mind that Marjolin ulcers can return even after they've been removed. If you've previously had a Marjolin ulcer, make sure you follow up regularly with your doctor. Tell them about any changes you notice around the affected area.

WebMD Medical Reference

Sources

SOURCES:

Dermatology Online Journal: "Squamous cell carcinoma in chronic wound: Marjolin ulcer."

Journal of the American College of Clinical Wound Specialists: "A Comprehensive Review on Marjolin's Ulcers: Diagnosis and Treatment."

JCO Global Oncology: "Systematic Review of Modern Case Series of Squamous Cell Cancer Arising in a Chronic Ulcer (Marjolin's Ulcer) of the Skin."

Lippincott Nursing Center: "Marjolin Ulcer: "A Comprehensive Review."

SKIN CANCER FOUNDATION: "Mohs Surgery."  

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