Late and Most Severe Complication of Burn Injury: Marjolin Ulcer

Abstract

OBJECTIVES: We analyzed the demographic characteristics, surgical interventions, results, and complications of patients in our clinic diagnosed with squamous cell carcinoma that developed on the base of burn scars. Our aim was to enhance the understanding and 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 postoperative follow-up.

RESULTS: Of the 741 patients diagnosed with squamous cell carcinoma, 11 had a burn-related Marjolin ulcer. Average age was 53 years, and average time from burn to squamous cell carcinoma diagnosis was 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 patients had margins with pseudoepithelial hyperplasia and dysplastic epithelium. Local recurrence developed in 2 patients during postoperative follow-up, with an average follow-up period of 4.8 years.

CONCLUSIONS: Marjolin ulcers derived from burn scars present major clinical challenges. A thorough surgical and clinical approach, coupled with careful follow-up, is essential for optimal management. In contrast to prevailing literature suggesting a poor prognosis for squamous cell carcinoma from burn scars, our findings showed no distant metastasis among our patients. For a more comprehensive understanding and improved patient care, multicenter studies are recommended and enhanced patient education is needed on protective measures and the importance of regular follow-up.