Giant exophytic Marjolin`s ulcer of the lower leg after the gunshot wound

Abstract

Introduction. Marjolin’s ulcer is a skin malignancy that occurs on a scar or chronic wound. It most commonly occurs on a burn scar. Squamous cell carcinoma is the most common type of this tumor in more than 90% of cases. The rate of this rare malignant transformation is 1–2%. Marjolin’s ulcer is more aggressive than other skin cancers. Wide excision is the treatment of choice. Recurrences are common. We present a large exophytic carcinoma of the lower leg as a rare form of this tumor ac-cording to the size and type together with reconstruction results. Case report. A 52-year-old man was presented with a large exophytic tumor on the left lower leg. The tumor was located at the site of the previous gunshot in-jury. The latent period was 22 years. Tumor size was 14 × 12 cm. Wide excision was performed (2-cm surgical margin), including the deep fascia, and the defect was closed by a split-thickness skin graft from the opposite thigh. Histology showed well-differentiated squamous cell carcinoma. There were no regional or distant metastases. One year after surgery, there was no recurrence of the tumor. Conclusion. Early diagnosis of Marjolin’s ulcer and wide excision are mandatory. Surgical margins for excision should be 2 cm, and excision should include deep fascia. Multiple and repeated biopsies of chronic wounds are advised. There is no consensus on the staging of Marjolin’s ulcer and lymph node dissection.

Keywords

• burns
• carcinoma, squamous cell
• cicatrix
• leg
• reconstructive surgical procedures
• wounds, gunshot