Marjolin's ulcers in south eastern Nigeria - A 15 year review at the close of the last millennium

Abstract

Objective: Marjolin's ulcers first reported by Celsius more than 2000 years ago still have a poor prognosis with poorly understood evolution. Thought to be rare, it has been reported to be commoner in sub-Saharan Africa including southern Nigeria, with a more aggressive natural history. Thus an attempt is made to review the pattern of presentation of marjolin's ulcers, and challenges of management in South Eastern Nigeria as at the close of the last millennium.

Method: Case records of patients managed for marjolin 's ulcers at the National Orthopaedic Hospital, Enugu, Nigeria from January 1980 to December 1994 were reviewed. The data obtained were analyzed using descriptive statistics.

Results: Seventy (70) patients were managed for marjolin's ulcers in the period under review, constituting 27%of primary skin cancers managed in that period. The mean age of the patients was 44.9 years with a male: female ratio of 2:1 Thirty seven (53%) arose from an active chronic ulcer while 33(47%) originated from previous scars with an average interval of onset of 22.1yrs. The post-burn scars had a shorter interval of onset of 11.6yrs, compared to 29.8 yrs for the nonburn scars.  The lower limbs were most commonly involved (71%), while the trunk was least involved (3%). Squamous cell carcinoma was the histologic type in 66 (95%) patients. Fifty two (74%) patients commenced treatment with amputation being the commonest form of treatment offered. Follow up was poor as only 3% had follow up for up to 5 years or until death.

Conclusion: This study has shown that about 50% of Marjolin's ulcers arose from unstable scars and were therefore potentially preventable. Improved access to appropriate healthcare as captured in the millennium development goals should reduce the incidence and improve outcome.

Keywords: Marjolin's ulcer Pattern; Management Challenges; Southeastern Nigeria; Millennium Review