Agarwal, Arjun

Ganesh, M S

Keerthi, B R

Reddy, Sreekanth

Shivkumaran, Sathyanarayan

English

Atharva Scientific Publications (E-Jounals)

Vol 2 Issue 3 Jul – Sep 2016                                                         Indian J Case Reports / 85 
Spot the Diagnosis 
Marjolin’s Ulcer: a form of chronic non healing ulcer 
Arjun Agarwal, Sreekanth Reddy, B R Keerthi, M S Ganesh, Sathyanarayan Shivkumaran 
From, Department of Surgical Oncology, Vydehi Institute of Medical Sciences, Bengaluru, India 
Correspondence to: Dr Arjun Agarwal, Vydehi Institute of Medical Sciences, Bengaluru, India Email: arjunbly@hotmail.com 
Received: 27 June 2016           Initial Review: 09 July 2016           Accepted: 20 July 2016           Published Online: 14 August 2016 
_____________________________________________________________________________________
QUERY 
A man sustained thermal injury 30 years ago and now he 
had presented with an ulcer in the left posterior axillary 
region with serous discharge as shown in figures. What is 
the probable diagnosis? 
 
Figures: Fig A - Man who sustained thermal injury 30 years ago, Fig B - Showing left posterior axillary region with a 10 x 8 cm 
indurated ulcer with everted edges and exuberant granulation tissue with serous discharge.  Fig C – Showing keratin pearl seen with 
cytoplasmic keratinisation within neoplastic cells, Fig D - Showing acanthotic epidermis with invading sheets and nests of atypical 
squamous cells having high N:C ratio and moderate nuclear pleomorphism. 
Vol 2 Issue 3 Jul – Sep 2016                                                         Indian J Case Reports / 86 
ANSWER: Marjolin’s Ulcer, A Well Differentiated 
Squamous Cell Carcinoma 
Marjolin's ulcer is defined as malignant degeneration 
arising within the pre-existing scar tissue or even in 
chronic inflammatory skin lesions. The most frequent site 
is in the lower extremity, especially the plantar foot. The 
leading cause is chronic burn wounds, as described 
originally by Marjolin [1]. The average age of latency is 
30 to 35 years with a range from 11 to 75 years [1]. 
The classic triad of nodule formation, induration, and 
ulceration at a scar site suggest the diagnosis. In most 
instances, biopsied lesions demonstrate well-differentiated 
squamous cell tumors but can be basal cell or melanoma. 
Depending on the size and stage of the ulcer, wide 
excision with grafting or amputation is the mainstay of 
treatment [1]. 
To prevent this wound degeneration into squamous cell 
carcinoma, it is imperative to provide early and definitive 
wound coverage or replacement of unstable scar tissue 
with healthy tissue. Although prevention is ideal, a high 
index of suspicion in chronic wounds is necessary so that 
early detection can prevent metastatic disease, which 
carries with it a poor prognosis [2]. 
REFERENCES 
1. Pekarek B, Buck S, Osher LJ. A Comprehensive Review 
on Marjolin's Ulcers: Diagnosis and Treatment. Am Col 
Certif Wound Spec. 2011; 3(3): 60–64. 
2. Tobin C, Sanger JR. Marjolin’s Ulcers: A Case Series and 
Literature Review. Wounds. 2014; 26(9): 248-254. 
 
 
 
 
 
 
 
 
How to cite this article: Agarwal A, Reddy S, Ganesh 
MS, Keerthi BR, Shivkumaran S. Marjolin’s Ulcer: a 
form of chronic non healing ulcer. Indian J Case Reports. 
2016; 2(3): 85-86. 
Conflict of interest: None stated, Funding: Nil 


Marjolin’s Ulcer: a form of chronic non healing ulcer

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Marjolin’s Ulcer: a form of chronic non healing ulcer

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