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Global Journal of Surgery. Volume 1, Issue 2 (2010) pp. 154-158
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Research Article
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Marjolin’s ulcer: Therapeutic challenges
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Maurice E. Asuquoa*, Otei O. Oteia, Victor I. Nwagbaraa, Godwin Ebugheb, Joshua Omotosob
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Departments of Surgerya and Pathologyb, University of Calabar Teaching Hospital, GPOBox 1891, Calabar - 540001, Nigeria
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Abstract |
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Introduction: In the developing world, chronic ulcers, scars, and osteomyelitic sinuses are commonplace, though malignant degeneration is rare, when poorly managed, may result in Marjolin’s ulcer. Experimental: We evaluated patients seen at the University of Calabar Teaching Hospital, Calabar from January 2005 through December 2009, who had histologic diagnosis of Marjolin’s ulcer. Results: The 14 patients were 9 males and 5 females (M:F=1.8:1) whose ages ranged from 16 to 70 years (mean 44.9 years). They accounted for 36.8% of squamous cell carcinoma and 14.3% of total skin cancer seen during the same period. Trauma was the leading cause of injury resulting in ulceration: road traffic injuries (six patients, 44.0%), falls (two patients, 14.0%). Others were chronic osteomyelitis (three patients, 21.0%), scar (two patients, 14.0%) and burns (one patient, 7.0%). All the injuries involved the limbs: lower (thirteen patients, 93.0%), and upper (one patient, 7.0%). The histologic diagnosis in 13 cases was squamous cell carcinoma (SCC), one basaloid SCC and mean latency period was 17.1 years. Three patients were managed with excision and skin grafting with the lesions healed. Three (21.0%) had amputation while others declined amputation or were lost to follow up. Hospital mortality was recorded in 2 (14.0%) patients. Conclusions: Ignorance, sociocultural, and economic factors were identified underlying issues. Prophylaxis by ensuring prompt and stable healing of chronic ulcers, health education focused on prevention of risk associated with chronic wounds and early presentation would improve outcome.
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Keywords |
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Marjolin's uler; Trauma; Therapeutic challenges
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