Marjolin Ulcers Arising on Extremities

Marjolin ulcer, epidermoid carcinoma arising on nonhealing scar tissue, is well known for its aggressiveness compared with other forms of squamous cell carcinoma. It is thought to be even more aggressive when it arises on an extremity. Therefore, Marjolin ulcer located on an extremity is unique in its aggressiveness and calls for immediate attention and extensive surgery. We have treated 81 patients with extremity lesions between 1982 and 2003, 62 of which have been followed up for at least 5 years. The cases that were lost to follow-up and our more recent cases have not been included in this study. Medical records of these 62 patients were reviewed retrospectively. All the lesions were carcinomas arising on old burn scars. The mean age was 48.0 years. The average interval between burn and carcinoma was 35.9 years. Male to female ratio was approximately 1:2. About 72.6% of the patients were treated with wide local excision only and 21.0% of the patients had wide excision together with regional lymph node dissection. Only 6.4% of the cases have been treated with amputation combined with regional lymph node dissection. Postoperative regional lymph metastasis was seen in 40.3% of the patients and 41.9% of the patients have developed lung metastasis during the follow-up. Presence of metastasis, high histologic grade, and tumor size were found to have a direct effect on survival rates. The mean survival was 4.55 for the whole study group. The 5-year survival rate was 42.9% in upper extremity and 58.3% in lower extremity groups. Estimated mean time of survival for the disease has been calculated to be 7.76 years using statistical analysis. We suggest that tumor size is an important prognostic factor in addition to histologic grade. Treatment algorithm is reviewed, and the importance of adequate surgery is emphasized.