Advanced Marjolin's ulcer of the scalp in a 13-year-old boy treated by excision and free tissue transfer: Case report and review of literature
15 January 2020 (online)
Marjolin's ulcer originates in chronic scars and wounds of diverse origin. This relatively rare tumour is most commonly a squamous cell carcinoma. The reason for malignant transformation is not well understood. The burn scar is a common predilection. We present the youngest patient in the literature, a 13-year-old male with a locally advanced squamous cell carcinoma of the scalp with intracranial extension following an unhealed burn injury at the age of three. Bilateral cervical lymphadenopathy was also noted. The tumour was excised and the large defect overlying the brain was covered by free latissimus dorsi musculocutaneous flap. At four weeks a therapeutic bilateral selective neck dissection was done. Adjuvant chemotherapy was administered. This report reiterates the importance of early diagnosis. Free tissue transfer further enhances our ability to cover complex defects associated with excision of advanced lesions.
- 1 Suhag V, Singh S, Nimbrian VK, Dimri K, Sharma N. Marjolin's Ulcer developing in electrical burns: A rare case report. Pak J Med Sci 2005;21:375-6.
- 2 Mathes SJ. Tumors of head, neck and skin. Management of non melanoma skin cancer. Plastic Surgery. 2nd ed. Elsevier Inc; Vol 5, 2006. p. 437-9.
- 3 Hahn SB, Kim DJ, Jeon CH. Clinical study of Marjolin's ulcer. Yonsei Med J 1990;31:234-41.
- 4 Er-Fan X, Li AO, Shi-ling W, Shao-Yu K, Guang-Xiu C. Burn scar carcinoma: Case reports and review of the literature. Ann MBC 1992;5:2.
- 5 Bostwick J, Pendergrast JW, Vasconez LO, Ulcer M. An immunopriviledged tumor. Plast Reconstr Surg 1976;57:66-8.
- 6 Thio D, Clarkson JH, Misra A, Srivastava S. Malignant change after 18 months in a lower limb ulcer: Acute Marjolins ulcer revisited. Br J Plast Surg 2003;56:825-8.
- 7 Cavadas P, Baena-Montilla P, Jorda-Ceuvas M, Vera-Sempere FJ. Primary intracranial malignant tumor mistaken for a postburn scalp Marjolins ulcer. Burns 1996;22:331-4.
- 8 Copcu E, Culhaci N. Marjolins ulcer on the nose. Burns 2002;28:701-4.
- 9 Nina G, Charalambos M, Chris B, Buettemeyer R. Squamous cell carcinoma arising on a skin graft 64 years after the primary injury. Dermatol Online 2007;13:2.
- 10 Celikoz B, Demiriz M, Selmanpakoglu. A shorter lag period of Mesenchymal Malignancy on Marjolin's ulcer. Burns 1997;23:72-4.
- 11 Ryan RF, Litwin MS, Krementz E. A new concept in the management of Marjolin's ulcers. Ann Surg 1981;193:598-605.
- 12 Bauer T, David T, Rimareix F, Lortat-Jacob A. Marjolin's ulcer in chronic osteomyelitis: Cases and review of the literature. Rev Orthop Surg 2007;93:63-71,
- 13 Akoz T, Erogan B, Gorgu M, Aslan G. The necessity for aggressive treatment with Marjolin' ulcer of the scalp. Plast Reconstr Surg 1997;100:805-6.
- 14 Sus WS, Chi HI, Woo CS, Haw CR, Yoon JI, Lim SD. Two cases of Marjolin's ulcer. Korean J Dermatol 1982;20:891-7.
- 15 Bizhko IP, Slesarenko SV. Operative treatment of deep burns of the scalp and skull. Burns 1992;18:20-3.
- 16 Copcu E, Aktas A, Oztan Y. Thirty one cases of Marjolin's ulcer. Clin Exp Dermatol 2003;28:138-41.