ISSN: 2574-7800
Authors: Goel V*
Marjolin’s ulcers are skin cancers developing on preexisting chronic inflammatory skin lesions. Most common histology is squamous cell carcinoma followed by basal cell carcinoma and malignant melanoma. Rarely fibrosarcoma, angiosarcoma, liposarcoma, leiomyosarcoma, osteosarcoma, dermatofibrosarcoma protuberans, malignant fibrous histiocytoma is reported [1]. The incidence of Marjoli’s ulcer is following a constant increasing trend. Marjolin’s ulcers are more common in males. Male to female ratio is 2:1. The Marjolin’s ulcer is a disease of middle and old age. The mean age of presentation being 55 years. But in recent times, more and more young patients are reporting with a Marjolin’s ulcer. The leading aetiology of the ulcer is a post-burn wound. All types of burns: thermal, electrical, chemical and radiation burns can lead to a Marjolin’s ulcer. Other causes being chronic traumatic ulcers, venous ulcers, chronic sinuses of osteomyelitis, pressure sores. Pathogenesis of Marjolin’s ulcer is multifactorial. In the chronic non healing ulcer there is a constant epidermal cell proliferation with immature granulation and epidermal tissue formation. In these immature cells, there is a mutation of p53 and other tumour suppressor genes. The p53 tumour suppressor gene prevents uncontrolled multiplication of cells by repairing damaged DNA or by signalling for apoptosis. If p53 is mutated or lost, appropriate DNA repair and/or apoptosis do not occur. As the cell cycle progresses mutated daughter cell multiplies unchecked, leading to cancer [2]. Another factor postulated is reduced vascularity in the ulcer bed. Reduction in the Langerhans cell population because of reduced vascularity leads to loss of defence forces with inability to withstand carcinogens. There is a time period (Transition time) from onset of ulcer to the transformation of the ulcer into malignancy. Transition time is the period from the onset of injury/ulcer to the development of Marjolin’s ulcer. The transition time is variable, ranging from three months to 63 years. The average transition time is 26 years [3]. Over the years the transition time is getting shorter. If transition time is < 2- 3years, it is called acute Marjolin’s ulcer. The lower limbs are the most common site of Marjolin’s ulcers, constituting almost 50 % of all cases. Other sites in descending order being upper extremities, head and neck and trunk.
Keywords: Skin Cancers
