Early Marjolin’s ulcer developing in a penile human bite scar of an adult patient presenting at Bugando Medical Centre, Tanzania: A Case Report

Abstract

Marjolin’s ulcer is a rare but well documented cutaneous malignancy that arises in a scar or chronic ulcer, and is characterized by an aggressive course. The latent period from the injury to the appearance of cancer has been reported to be 25-40 years. Early occurring Marjolin’s ulcer has rarely been described in the literature and its development in a penile human bite scar is still rare. We report a rare case of a 33 year-old patient who presented with an early appearance of Marjolin’s ulcer developing in a penile human bite scar. On histological examination it was found to be poorly differentiated squamous cell carcinoma. He was managed by total penile amputation. Five months after surgery, the patient presented to our surgical outpatient clinic with inguinal lymph node metastases and distant metastases to the lung, liver and bones. However, the patient died shortly after admission. This report highlights the possibility of early appearance of Marjolin’s ulcer arising from a chronic ulcer or healed scar in an unusual sites such as the penis. It is therefore recommended that all chronic ulcers should be thoroughly investigated at presentation, to avoid labelling malignancies ‘chronic ulcers’, leading to delay in appropriate treatment. Early recognition and aggressive treatment of Marjolin's ulcers and close follow-up are urgently needed to improve outcomes in our environment.