Marjolin's ulcers at a university teaching hospital in Northwestern Tanzania: a retrospective review of 56 cases

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

Report of the Study Group "Economic and Monetary Union 1980" and Annex I. 8 March 1975. (commonly called the Marjolin Report)

[PREFACE]. At the start of 1974, the European Commission asked a group of experts in different scientific fields (economists, lawyers,...) to draw up a study on economic and monetary union (EMU). The group of experts, called the "Study Group on Economic and Monetary Union 1980" has met under the chairmanship of Robert Marjolin, former Vice-president of the Commission, in charge of economic and monetary affairs. [From the Introduction]. The report is divided into four chapters. The first draws up a balance sheet of past events and an analysis of the movement towards economic and monetary union. The second deals with the urgent problems which endanger the existence of the European Community. This chapter is followed by a short term programme (Chapter 3), which given the evolution which the Community has undergone in recent years, is still largely devoted to monetary policy. In general, however, this programme can be considered as a test of the political will of the member states's governments. Finally chapter IV examines in greater detail the first steps towards economic and monetary union. Two annexes are added to the report: annex I contains details of the Group's proposal relating to a Community unemployment benefit scheme and which has the agreement of all the members of the Group. Annex II brings together some personal contributions

Coopération intergouvernementale et autorités supranationales

Marjolin Robert. Coopération intergouvernementale et autorités supranationales. In: Revue économique, volume 9, n°2, 1958. pp. 267-277