Hemicorporectomy for chronic pressure ulcer carcinoma: 7 years of follow-up.

Development of squamous cell carcinoma (Marjolin's ulcer), a well-known and rare complication of chronic ulcers, sinuses, chronic osteomyelitis and burn scars, may complicate chronic pressure ulcers. For several years, reports have suggested these cancers (pressure sore carcinoma, PSC) are highly fatal and aggressive, unlike other Marjolin's ulcers. A 39-year-old male, paraparetic from spina bifida, with history of chronic pressure sores and osteomyelitis of the pelvic bones underwent multiple resections. A descending colostomy was performed to avoid soiling of the perineum and decubitus ulcers. He developed squamous cell carcinoma in multiple pelvic areas. He was dependent on two daily visits by home care nurses for wound care. After negative workup for metastasis, as his only chance for cure he was offered hemicorporectomy, which was performed at the L4-L5 disc level. A prosthesis was applied 1 month after the surgery. As of November 2003, he remains disease-free after 7 years (90 months) from initial surgery. He is employed as a computer programmer, is self-dependent, and also drives. Aggressive treatment in select patients with PSC is essential and can lead to long-term disease control and increase in overall quality of life.