Giant exophytic Marjolin’s ulcer of the lower leg after a gunshot wound

Dejan  Vulović; Vesna  Stanković; Tatjana  Vulović Šarenac; Bojan Milošević; Maja  Vulović; Dragče Radovanović; Marko Spasić

doi:10.2298/VSP201110011V

Dejan Vulović University Clinical Center of Kragujevac, Center for Plastic Surgery, Kragujevac, Serbia
Vesna Stanković University Clinical Center of Kragujevac, Department of Pathology, Kragujevac, Serbia
Tatjana Vulović Šarenac University Clinical Center of Kragujevac, Clinic for Ophthalmology, Kragujevac, Serbia
Bojan Milošević University of Kragujevac, Faculty of Medical Sciences, Department of Surgery, Kragujevac, Serbia
Maja Vulović University of Kragujevac, Faculty of Medical Sciences, Department of Anatomy, Kragujevac, Serbia
Dragče Radovanović University of Kragujevac, Faculty of Medical Sciences, Department of Surgery, Kragujevac, Serbia
Marko Spasić University of Kragujevac, Faculty of Medical Sciences, Department of Surgery, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP201110011V

Keywords: burns, carcinoma, squamous cell, cicatrix, leg, reconstructive surgical procedures, wounds, gunshot

Abstract

Introduction. Marjolin’s ulcer is a skin malignancy that occurs on a scar or chronic wound. It most commonly occurs on a burn scar. Squamous cell carcinoma is the most common type of this tumor in more than 90% of cases. The rate of this rare malignant transformation is 1–2%. Marjolin’s ulcer is more aggressive than other skin cancers. Wide excision is the treatment of choice. Recurrences are common. We present a large exophytic carcinoma of the lower leg as a rare form of this tumor according to the size and type together with reconstruction results. Case report. A 52-year-old man was presented with a large exophytic tumor on the left lower leg. The tumor was located at the site of the previous gunshot injury. The latent period was 22 years. Tumor size was 14 × 12 cm. Wide excision was performed (2-cm surgical margin), including the deep fascia, and the defect was closed by a split-thickness skin graft from the opposite thigh. Histology showed well-differentiated squamous cell carcinoma. There were no regional or distant metastases. One year after surgery, there was no recurrence of the tumor. Conclusion. Early diagnosis of Marjolin’s ulcer and wide excision are mandatory. Surgical margins for excision should be 2 cm, and excision should include deep fascia. Multiple and repeated biopsies of chronic wounds are advised. There is no consensus on the staging of Marjolin’s ulcer and lymph node dissection.

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