The increasing burden of Marjolin’s ulcer in North Eastern Nigeria: A 10 year study and review of literature

Abstract

Introduction: Marjolin’s ulcers are cutaneous malignancies arising from scars, chronic wounds or inflammations. The incidence of this disease is on the increase in developing countries were conservative wound management is still widely practiced. The aim of this study is to evaluate the current clinical pattern of Marjolin’s’ ulcer, its treatment outcome and compare with earlier studies done elsewhere.
Method: The case records of 36 patients managed in University of Maiduguri Teaching hospital from 2001 to 2010 were retrospectively studied for demographic characteristics, predisposing lesions, latent period, duration of malignant ulcer, sites of the lesion, metastasis, histology, treatment modalities and outcome.
Results: the average age of patients in this study was 40.8 years with male to female ration of 2:1. The average latent period from injury to development of Marjolin’s ulcer was 22.1 years. Frequencies of predisposing lesions were, burns 69.4%, trauma 16.7% and others like chronic osteomyelitis, frunculosis, snake bite, Steven Johnson syndrome scar have frequency of 2.78% each. The lower limb is the commonest site affected and Squamous cell carcinoma was diagnosed in 94.4% of cases with malignant fibrous histiocytomas and melanoma in 5.6%. Bony infiltration is seen in 30.6% of cases, regional nodes metastases in 33% with mortality rate of 8.3%.
Conclusion: Marjolin’s ulcer is an aggressive cancer with high metastatic and mortality rates. Active surgical management of wounds with provision of early wound cover will decrease the burden of this disease in our environment. 

Keywords: Marjolin’s ulcer, North Eastern Nigeria, squamous cell carcinoma