How Does Marjolin Ulcer Develop & How is it Treated?

Marjolin ulcers are a rare and aggressive type of skin cancer that grows from burns, poorly healed wounds, and scars. Jean Nicolas Marjolin first described these specific cancer changes in scar tissue and they got named after him.⁽¹⁾ Marjolin ulcers are also known as burn ulcers.

Marjolin ulcers, in the early stages, look as flat and hard sores at the site of a scar or burn, which is not healing for 3 months or more. They often start as small blisters over an old scar. As the sore form, there may be a foul smell, bleeding, severe pain, and crusting. The ulcer may open and close repeatedly and may also continue to grow.

Marjolin ulcers develop from previous traumatized, hurt, and skin that is chronically inflamed. 2 percent of Marjolin ulcers develop from burn scars.⁽²⁾ They can also develop from bone infections, open sores, amputation, skin grafts, vaccination scars, radiation-treated scars, and snakebite scars.⁽¹⁾

These areas of skin damage turning into cancer may be due to the following reason:

• Injury destroys the blood vessels and lymphatic vessels. These are the parts of the body’s immune response making it harder for the skin to fight off cancer.
• When there is long-term irritation, the skin cells constantly repair themselves and during this process skin cells become cancerous.

It is seen that men are more likely to develop Marjolin ulcers than women.⁽³⁾

Most of the Marjolin ulcers are squamous cell cancers as they develop in the upper layers of the skin. Sometimes they develop in the deeper layers and are basal cell tumors.

Marjolin ulcers grow slowly and may take 30-35 years to turn cancerous. Irritation and damage around the injured area are the first sign of Marjolin ulcers. The skin itches, burns, and forms blisters. Soon a new open sore develop that is filled with several hard lumps around the injured area. This makes them look like flat ulcers with edges that are raised. Marjolin ulcers are more likely to grow on the head, neck, legs, and feet.

A doctor refers a person to a dermatologist if he has a scar that has not healed even after 3 months. If the sore is suspected to be cancerous a biopsy is done, in which a small sample from the wound is taken and is tested for cancer.

Ultrasound is done to examine the surrounding lymph nodes and if anything suspicious is detected the lymph node near the sore is removed and tested for cancer and this procedure is known as sentinel lymph node biopsy. Depending on the result of the biopsy, a CT scan and MRI scan are done to make sure that cancer does not spread to bones and other organs.

The treatment of Marjolin ulcer is the removal of the tumor. The different methods of surgery are:

• Excision: Cutting and removing the tumor and some of the tissue surrounding it.
• Mohs Surgery: This surgery involves stages, where first the surgeon removes a layer of skin and looks at it under a microscope. The process is repeated until there is no cancer left.

After the surgery, a skin graft is needed to cover the area from where the skin is removed. Even after the treatment, a follow-up with the doctor is recommended.

To prevent Marjolin ulcers or severe burns, it is important to get emergency help. This can help in reducing the risk of developing Marjolin ulcers. For sores and burns not healing after 2-3 weeks, medical attention is a must. Also, if an old burn or scar starts developing a sore, a doctor should be informed.

Marjolin ulcers are a very serious type of skin cancer and the outlook depends on the size of the tumor and how aggressive it is. Additionally, Marjolin ulcers can return even after they have been removed. Therefore, if someone had a Marjolin ulcer in past, regular follow-up with a doctor is important.