To explore the epidemiology and therapeutic methods of Marjolin′s ulcer.

Between January 2001 and September 2013, fifty-one patients with Marjolin′s ulcers were admitted to the departments of Burn and Plastic Surgery of the First People′s Hospital of Foshan and the Second Affiliated Hospital of Sun Yat-sen University. Data were collected including their age, gender, time from initial ulceration to carcinomatous change, cause of initial ulceration, history of ulcer treatment, surgical treatment and follow-up results. The associations between pathological type and metastasis and between location of squamous cell carcinoma (SCC) and metastasis were analyzed. Eleven patients with deep, aggressive SCC or melanoma and suspected sentinel lymph node metastasis underwent positron emission tomography-computer tomography (PET-CT) and B-mode ultrasound-guided biopsy. All patients were followed up until death.

The 51 patients with Marjolin′s ulcers included 22 male (43.14%) and 29 female (56.86%) with mean age of 64.15 years (range, 32-89 years). The mean time from initial ulceration to diagnosis of SCC was 13.42 years (range, 6 months -54 years) and the time to diagnosis of melanoma was 2.47 years (range, 3 months -10 years) and one patient developed epitheliod sarcoma after 2 years and one developed basal cell carcinomas after 3 years. Four pathological types include 43 cases of SCC, 6 cases of melanoma, 1 case of epitheliod sarcoma and 1 case of basal cell carcinomas. Among patients with SCC, 30.82% had sentinel lymph node metastasis and 9.09% distant metastasis while patients with melanoma, 66.67% had sentinel lymph node metastasis and 33.33% distant metasrasis.PET-CT and B-mode ultrasound were successfully used for detecting early lymph node metastasis in 11 Marjolin′s ulcer patients with 100% accuracy rate. For 27 patient of SCC without metastasis and aggressive tumor, extended resection and skin graft or skin flap operation were conformed. Only one patient died for distant metastasis 3 years later and the others survived. Four of 5 patients of SCC with aggressive tumor survived after amputation while 1 of 5 patient died for rejecting amputation for distant metastasis 1 year later. Nine of 11 SCC patients with aggressive tumor and sentinel lymph node metastasis underwent amputation and lymph node dissection. Eight patients survived and one patient died for distant metastasis 2 years after operation. One patient died two years later for rejecting operation. One patient was unfit for operation for multiple lymph node metastasis and died one year later. For 2 of 6 patient of melanoma on foot without metastasis and aggressive tumor survived after extended resection and skin graft or skin flap operation were conformed. Two of 3 patients of melanoma on foot with sentinel lymph node metastasis survived after underwent amputation or extended resection and lymph node dissection while one patient died 6 months later for rejecting operation. One patient with sentinel lymph node metastasis and lungs metastasis died 6 months later without operation.

SCC and melanoma are more common in Marjolin′s ulcers, which have a higher rate of metastasis. PET-CT and B-mode ultrasound-guided biopsy can be successfully used for the detection of sentinel lymph node metastasis with 100% accuracy rate while PET-CT cannot be singly used to detect the sentinel node metastasis. The SCC was often treated by extended resection and skin grafting or skin flap. Patients with deep, aggressive tumor of an extremity and sentinel lymph node metastasis underwent amputation and lymph node dissection. This treatment can also be used for melanoma type Marjolin′s ulcer.