Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
World J Surg Oncol. 2012 Feb 15;10:38. doi: 10.1186/1477-7819-10-38.
Marjolin's ulcer is a rare but highly aggressive squamous cell cancer that is most often associated with chronic burn wounds. Although many individual case reports exist, no comprehensive evaluation of Marjolin's ulcer patients has been conducted in our setting. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our local setting and to identify predictors of outcome.
This was a retrospective study of histologically confirmed cases of Marjolin's ulcer seen at Bugando Medical Centre over a period of 10-years between January 2001 and December 2010. Data were retrieved from patients' files and analyzed using SPSS computer software version 15.0
A total of 56 patients were studied. Male to female ratio was 2.1:1. Burn scars (89.3%) were the most common causative lesions of Marjolin's ulcer. The mean latent period between original injury and diagnosis of Marjolin's ulcer was 11.34 ± 6.14 years. Only 12.0% of the reported cases were grafted at the time of injury (P < 0.00). Most patients (48.2%) presented between one and five years of onset of illness. The lower limb (42.9%) was the most frequent site for Marjolin's ulcers. The median tumor size at presentation was 8 cm and the vast majority of patients (85.7%) presented with large tumors of ≥ 5 cm in diameter. Lymph node metastasis at the time of diagnosis was recorded in 32.1% of cases and distant metastasis accounted for 26.9% of cases. Squamous cell carcinoma (91.1%) was the most common histopathological type. Wide local excision was the most common surgical procedure performed in 80.8% of cases. Post-operative complication rate was 32.1% of which surgical site infection was the most common complication in 38.9% of patients. Local recurrence was noted in 33.3% of cases who were treated surgically. The mean length of hospital stay for in-patients was 7.9 ± 2.3 days. Mortality rate was 7.1%. According to multivariate logistic regression analysis, stage and grade of the tumor and presence of local recurrence were the main predictors of death (P < 0.001).
Marjolin's ulcers are not rare in our environment and commonly occur in burn scars that were not skin grafted and were left to heal secondarily. A high index of suspicion is required in the management of chronic non-healing ulcers and all suspected lesions should be biopsed. Early recognition and aggressive treatment of Marjolin's ulcers and close follow-up are urgently needed to improve outcomes in our environment.
恶性溃疡是一种罕见但高度侵袭性的鳞状细胞癌，最常与慢性烧伤创面有关。尽管有许多单独的病例报告，但在我们的环境中尚未对恶性溃疡患者进行全面评估。本研究旨在描述我们当地环境中这种情况的临床病理表现和治疗结果，并确定预后的预测因素。
这是一项回顾性研究，对 2001 年 1 月至 2010 年 12 月期间在布干达医疗中心确诊的恶性溃疡病例进行了研究。数据从患者档案中检索，并使用 SPSS 计算机软件版本 15.0 进行分析。
共研究了 56 例患者。男女比例为 2.1:1。烧伤疤痕（89.3%）是恶性溃疡最常见的病因。原始损伤和恶性溃疡诊断之间的平均潜伏期为 11.34 ± 6.14 年。仅 12.0%的报告病例在受伤时进行了植皮（P<0.00）。大多数患者（48.2%）在发病后 1 至 5 年内就诊。下肢（42.9%）是恶性溃疡最常见的部位。就诊时肿瘤的中位大小为 8cm，绝大多数患者（85.7%）就诊时肿瘤直径≥5cm。诊断时记录到淋巴结转移 32.1%，远处转移占 26.9%。组织病理学类型最常见的是鳞状细胞癌（91.1%）。广泛局部切除术是最常见的手术方式，占 80.8%的病例。术后并发症发生率为 32.1%，其中手术部位感染占 38.9%的患者。局部复发率为 33.3%，接受手术治疗的患者中有 33.3%。住院患者的平均住院时间为 7.9 ± 2.3 天。死亡率为 7.1%。根据多变量逻辑回归分析，肿瘤的分期和分级以及局部复发是死亡的主要预测因素（P<0.001）。
在我们的环境中，恶性溃疡并不罕见，常见于未植皮和继发性愈合的烧伤疤痕中。在处理慢性不愈合性溃疡时，需要高度怀疑，并对所有疑似病变进行活检。早期发现和积极治疗恶性溃疡，并密切随访，是改善我们环境中预后的迫切需要。
