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Acute Marjolins Ulcers: A Nebulous Diagnosis

Chang, Jessica B. BS*; Kung, Theodore A. MD; Cederna, Paul S. MD, FACS

doi: 10.1097/SAP.0000000000000134
Burn Surgery and Research

Abstract: Marjolin’s ulcers are rare cutaneous malignancies that most commonly present as squamous cell carcinomas in previously injured, chronically inflamed, or scarred skin. Acute and chronic types have been distinguished by the length of latency; by definition, the acute type occurs within 12 months of injury whereas the chronic type appears over 12 months after injury. In this report, 3 cases of acute Marjolin’s ulcers are described and questions are raised about the diagnosis of acute Marjolin’s ulcer. Other than a discrepancy in lag time, it is unclear if there is any difference in clinical or histological characteristics or even prognosis between acute and chronic Marjolin’s ulcers. In fact, the acute type may simply be a preemptive diagnosis that conveniently describes a carcinoma associated with a nonhealing wound and discovered within a short time span. Moreover, the rarity of the diagnosis and the relatively rapid rate of malignant degeneration from the inciting injury lead one to question whether the injury may have simply revealed or accelerated a previously existing occult cutaneous malignancy. With no definitive clinical, histological, or prognostic distinction between acute and chronic Marjolin’s ulcers, the use of such terminology may not benefit a clinician’s understanding or practice. In fact, it merely supports the clinical guideline that any nonhealing wound, acute or chronic, should be biopsied and sent for pathologic examination to ensure that it does not represent a Marjolin’s ulcer.

From the *University of Toledo College of Medicine, Toledo, OH; and †Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI.

Received June 23, 2013, and accepted for publication, after revision, December 13, 2013.

J.B.C. and T.A.K. are co-first authors.

Conflicts of interest and sources of funding: none declared.

Reprints: Paul S. Cederna, MD, FACS, Section of Plastic Surgery, Department of Biomedical Engineering, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0219. E-mail: cederna@umich.edu.

© 2014 by Lippincott Williams & Wilkins