Late and Most Severe Complications of Burn Injury: Marjolin Ulcer

Abstract

ABSTRACT

OBJECTIVES: The goal of our study was to analyze and present the demographic characteristics, surgical interventions, results, and complications of patients diagnosed with squamous cell carcinoma that developed on the base of burn scars in our clinic. Through this research, we aimed to enhance the understanding and to improve therapeutic strategies for the management of Marjolin ulcer. MATERIALS AND METHODS: We conducted a comprehensive review of patients who underwent surgery for squamous cell carcinoma from May 2013 to May 2023. We specifically identified those with squamous cell carcinoma originating from burn ulcers. For these patients, we systematically collected data, which encompassed demographic details, photographic evidence, details of surgical interventions, lymph node outcomes (if dissection occurred), and any recurrences or complications observed during the postoperative follow-up. RESULTS: Of the 741 patients diagnosed with squamous cell carcinoma, 11 had a burn-related Marjolin ulcer. The average age was 53 years, with an average time from burn to squamous cell carcinoma diagnosis of 12.2 years. Six patients had excisions with lymph node dissections. In 6 patients, the excision material was removed with a clean margin, whereas 3 had margins with pseudo-epithelial hyperplasia and dysplastic epithelium. Local recurrence developed in 2 patients during postoperative follow-up. Average follow-up period was 4.8 years. CONCLUSIONS: Marjolin ulcers derived from burn scars present substantial clinical challenges. A thorough surgical and clinical approach, coupled with careful follow-up, is essential for optimal management. In contrast to the prevailing literature that suggests a poor prognosis for squamous cell carcinoma from burn scars, our findings showed no distant metastasis. For a more comprehensive understanding and improved patient care, multicenter studies are recommended, and there is a pressing need to enhance patient education about protective measures and the importance of regular follow-up.