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Marjolin’s Ulcers in sub-Saharan Africa

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Abstract

Background

Cutaneous malignancies are considered rare among Africans. Trauma, its sequelae, and other chronic non-healing wounds are known to predispose to malignant degeneration. Not much is known of the demographics of Marjolin’s ulcers in sub-Saharan Africa.

Methods

Pathology records on patients suspected to have Marjolin’s ulcers submitted to the Pathology Department were extracted from a database of 75,124 specimens. A review of the English literature on Marjolin’s ulcers from Nigeria, a sub-Saharan country, was also performed.

Results

Of 210 specimens from suspected Marjolin’s ulcers, 167 records had a histological diagnosis of malignancy, with a male to female ratio of 1:1.4, and a mean age of 48 years (range: 4–97 years). There were 163 (97.6%) squamous cell carcinomas, 3 (1.8%) sarcomas, and 1 (0.6%) malignant melanoma. Burn scars, chronic ulcers, osteomyelitis, and “other” ulcers constituted 82 (49%), 70 (42%), 9 (5.4%), and 6 (3.6%), respectively. Subjects in six sub-Saharan Marjolin’s ulcer studies had a mean age between 36 and 42 years, with a mean latent period 16 years.

Conclusions

Marjolin’s ulcers in sub-Saharan African have a shorter latent period, and they occur in younger patients. Provision of early stable wound cover is essential for prevention of malignant degeneration of scars, while early appropriate intervention is crucial in the treatment of chronic ulcers.

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References

  1. Copcu E (2009) Marjolin’s ulcer: a preventable complication of burns? Plast Reconstr Surg 124:156e–164e

    Article  CAS  PubMed  Google Scholar 

  2. Ozek C, Cankayali R, Bilkay U et al (2001) Marjolin’s ulcers arising in burn scars. J Burn Care Rehabil 22:384–389

    Article  CAS  PubMed  Google Scholar 

  3. Aydoğdu E, Yildirim S, Aköz T (2005) Is surgery an effective and adequate treatment in advanced Marjolin’s ulcer? Burns 31:421–431

    Article  PubMed  Google Scholar 

  4. Fishman JRA, Parker MG (1991) Malignancy in chronic wounds: Marjolin’s ulcer. J Burn Care Rehabil 12:218–223

    Article  CAS  PubMed  Google Scholar 

  5. Asuquo M, Ugare G, Ebughe G et al (2007) Marjolin’s ulcer: the importance of surgical management of chronic cutaneous ulcers. Int J Dermatol 46:29–32

    Article  PubMed  Google Scholar 

  6. Lawrence EA (1952) Carcinoma arising in the scars of thermal burns. Surg Obstet Gynecol 95:579–588

    CAS  Google Scholar 

  7. Kowal-Vern A, Criswell BK (2005) Burn scar neoplasms: a literature review and statistical analysis. Burns 31:403–413

    Article  PubMed  Google Scholar 

  8. Celik E, Fyndyk H, Uzunismail A (2005) Early arising Marjolin’s ulcer: report of three cases. Br J Plast Surg 58:122–124

    PubMed  Google Scholar 

  9. Malheiro E, Pinto A, Choupina M et al (2001) Marjolin’s ulcer of the scalp: case report and literature review. Ann Burns Fire Disasters 15:115–118

    Google Scholar 

  10. Gardner AW (1959) Trauma and squamous skin cancer. Lancet 273:760–761

    Article  Google Scholar 

  11. Nthumba P (2010) “Blitz surgery”: redefining surgical needs, training and practice in sub-Saharan Africa. World J Surg 34:433–437

    Article  PubMed  Google Scholar 

  12. Bruckschwaiger O (1956) Surgical problems in Central and East Africa. Can Med Assoc J 75:658–663

    CAS  PubMed  Google Scholar 

  13. Iregbulem LM (1987) Post-burn squamous cell cancers in Nigerians. Br J Plast Surg 40:488–493

    CAS  PubMed  Google Scholar 

  14. Onuigbo WIB (2006) Epidemiology of skin cancer arisen from the burn scars in Nigerian Ibos. Burns 32:602–604

    Article  PubMed  Google Scholar 

  15. Onah II, Olaitan P, Ogbonnaya I et al (2006) Marjolin’s ulcer at a Nigerian hospital (1993–2003). J Plast Reconstr Aesthet Surg 59:565–566

    Article  CAS  PubMed  Google Scholar 

  16. Asuquo ME, Udosen AM, Ikpeme IA et al (2009) Cutaneous squamous cell carcinoma in Calabar, southern Nigeria. Clin Exp Dermatol 34:870–873

    Article  CAS  PubMed  Google Scholar 

  17. Nthumba PM (2007) Giant cutaneous horn in an African woman: a case report. J Med Case Rep 1:170

    Article  Google Scholar 

  18. Fleming ID, Barnawell JR, Burlison PE et al (1975) Skin cancer in black patients. Cancer 35:600–605

    Article  CAS  PubMed  Google Scholar 

  19. Amir H, Mbonde MP, Kitinya JN (1992) Cutaneous squamous cell carcinoma in Tanzania. Cent Afr J Med 38:439–443

    CAS  PubMed  Google Scholar 

  20. Templeton AC (1973) Tumours in a tropical country: a survey of Uganda, 1964–1968. Springer, Berlin, pp 182–183

    Google Scholar 

  21. Davies JNP, Tank R, Meyer R (1968) Cancer of the integumentary tissues in Uganda Africans: the basis for prevention. J Natl Cancer Inst 41:31–51

    CAS  PubMed  Google Scholar 

  22. Giblin T, Pickrell K, Pitts W et al (1965) Malignant degeneration in burn scars: Marjolin’s ulcer. Ann Surg 162:291–297

    Article  CAS  PubMed  Google Scholar 

  23. Sharma RK (2009) Is Marjolin’s ulcer always a squamous cell carcinoma? Shedding some light on the old problem. Plast Reconstr Surg 124:1005

    CAS  PubMed  Google Scholar 

  24. Lawrance REA (1952) Carcinoma arising in burn scars. Surg Gynecol Obstet 95:579–588

    Google Scholar 

  25. Nthumba PM, Oliech JS (2005) Outcome of moderate and severe thermal injuries at Kenyatta National Hospital. East Cent Afr J Surg 10:37–42

    Google Scholar 

  26. Onah II, Okwor B, Onuigbo WI (2010) Penetrating scalp Marjolin’s ulcer involving bone and dura mater in a Nigerian hospital: case report and literature review. Burns 36:39–43. doi:10.1016/j.burns.2009.04.010

    Google Scholar 

  27. Daya M, Balakrishan T (2009) Advanced Marjolin’s ulcer of the scalp in a 13-year-old boy treated by excision and free tissue transfer: case report and review of literature. Indian J Plast Surg 42:106–111

    Article  CAS  PubMed  Google Scholar 

  28. Olaitan PB, Ogbonnaya IS (2007) Marjolin’s ulcers on the thigh two years after burn. Ann Burns Fire Disasters 20:159–160

    Google Scholar 

  29. Love RL, Breidahl AF (2000) Acute squamous cell carcinoma arising within a recent burn scar in a 14-year-old boy. Plast Reconstr Surg 106:1069–1071

    Article  CAS  PubMed  Google Scholar 

  30. Enoch S, Miller DR, Price PE et al (2004) Early diagnosis is vital in the management of squamous cell carcinomas associated with chronic non healing ulcers: a case series and review of the literature. Int Wound J 1:165–175

    Article  PubMed  Google Scholar 

  31. Bostwick J, Pendergrast WJ, Vasconez LO (1975) Marjolin’s ulcer: an immunologically privileged tumor? Plast Reconstr Surg 57:66–69

    Google Scholar 

  32. Edwards MJ, Hirsch RM (1989) Squamous cell carcinoma arising in previously burned or irradiated skin. Arch Surg 124:115–117

    CAS  PubMed  Google Scholar 

  33. Rowe DE, Carroll RJ, Day CL Jr (1992) Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol 26:976–990

    Article  CAS  PubMed  Google Scholar 

  34. Ryan RF, Litwin MS, Krementz ET (1981) A new concept in the management of Marjolin’s ulcers. Ann Surg 193:598–604

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The author is grateful to the AIC Kijabe Hospital Pathology Department staff for assistance in retrieving patient records.

Conflict of interest

The author has declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, AIC Kijabe Hospital, Kijabe, 00220, Kenya

    Peter M. Nthumba

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  1. Peter M. Nthumba
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Correspondence to Peter M. Nthumba.

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Nthumba, P.M. Marjolin’s Ulcers in sub-Saharan Africa. World J Surg 34, 2272–2277 (2010). https://doi.org/10.1007/s00268-010-0727-6

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  • DOI: https://doi.org/10.1007/s00268-010-0727-6

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