In this installment of the series of posts on Chronic Wounds, we will spend some time on the topic of Marjolin’s ulcers. This term was based on the description of the development of secondary malignancy in chronic wounds by Jean-Nicolas Marjolin, a french surgeon who first described this lesion in 1828.
Development of Malignancy in a Chronic Ulcer
The development of malignancy in a chronic ulcer is not an uncommon event. It has been described in the literature that up to 10% of Chronic Ulcers will develop a secondary malignancy. While a variety of different malignancies have been described, it’s typically an invasive Squamous Cell Carcinoma (SCC) that is found. Other than a small number of basal cell carcinomas, it is possible that the other types of tumors identified are more often ulcerated primary carcinomas than secondary lesions.
Here are some interesting facts about Marjolin’s ulcers.
- Most are invasive SCC
- The interval between the initial development of a chronic ulcer or scar and the appearance of a secondary malignancy is typically measured in DECADES
- The interval between initial injury and the development of malignancy (i.e. lag time), decreases as the age of the individual at the time of injury advances. (i.e. injuries in older individuals typically develop a malignancy sooner than similarly injured young people)
- Different types of injuries (i.e. burns, osteomyelitis, others) have different rates of malignancy development
- In general, it is felt that a tumor that develops in a chronic wound will behave in a more aggressive fashion than a tumor that is in non-injured skin
How do you identify a malignancy in a chronic wound?
Perhaps the best way of detecting these lesions is to use a simple punch biopsy tool. Getting tissue under the microscope of a pathologist can provide you with an evaluation that can help identify the presence of malignancy…or confirm your clinical judgement. You should consider doing a punch biopsy of any chronic wound when there is ANY suspicion. If the wound is not behaving as you would expect for the treatment provided, you should consider the possibility of the wound being a malignancy or developing a malignancy and doing a punch biopsy for complete evaluation. In addition, the microscopic evaluation of a wound can help identify other elements of normal, and abnormal, wound healing, potentially providing the treating physician with information to help tailor treatment.
4path provides comprehensive wound biopsy evaluation, which includes detailed findings in the wound (not just a one line diagnosis…like most labs), as well as a comprehensive evaluation for the presence of primary and secondary malignancies.
Contact 4path today to provide this unique service to your patients with chronic wounds. Call 877-884-7284 (877-88-4path) or send us an e-mail to firstname.lastname@example.org to talk with a laboratory representative about this comprehensive program.
Image from Wikipedia.