Practice Easily Missed?

Marjolin’s ulcer

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3997 (Published 19 August 2015) Cite this as: BMJ 2015;351:h3997
  1. Robert Choa, plastic surgery specialty registrar1,
  2. Sukbhir Rayatt, consultant plastic and reconstructive surgeon1,
  3. Kamal Mahtani, general practitioner and National Institute for Health Research clinical lecturer2
  1. 1Department of Plastic Surgery Royal Stoke University Hospital, Stoke on Trent ST4 6QG, UK
  2. 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to: R Choa rob_choa{at}hotmail.com
  • Accepted 28 May 2015

The bottom line

  • Consider Marjolin’s ulcer in patients with a longstanding wound or scar that has undergone recent change and is refractory to basic wound care

  • If a Marjolin’s ulcer is suspected, refer for incisional biopsies of all suspicious areas, including the edge

  • Treatment is curative if the tumour is diagnosed early; these aggressive lesions can metastasise, resulting in high mortality

The tissue viability nurse refers a 72 year old woman with lower limb venous stasis and a six year history of a non-healing ulcer on her shin (figure) to her general practitioner. The GP refers her to the plastic surgery team, where incisional biopsy of the ulcer confirms squamous cell carcinoma (SCC), consistent with a Marjolin’s ulcer. Further examination shows palpable lymph nodes in the right inguinal region.

Marjolin’s ulcer of the right anterolateral leg. The ulcer has an irregular border and base. It had bled intermittently and had increased in size despite compression bandaging

What is a Marjolin’s ulcer?

Marjolin’s ulcers are tumours that most commonly arise from areas of chronic inflammation or injury and develop over many years.1 They are most common in old burn scars, but they are also seen in traumatic wounds, venous stasis ulcers, pressure sores, …

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