Marjolin’s ulcer at Soba University Hospital, Khrtoum, Sudan: a case series of fifty patients

Abstract

Background: Marjolin’s ulcer (MU) is a rare aggressive skin malignancy that complicates chronic nonhealing
wounds and scars. Studies have been conducted worldwide to report the risk factors and clinicpathological
features of this disease. Sudanese literature on the subject is scarce.
Objective: To describe the clinico-pathological features of Marjolin’s ulcer (MU) among a sample of
Sudanese patients who have been diagnosed with MU at Soba University Hospital (SUH), Khartoum,
Sudan.
Patients and Methods: This is a descriptive, analytical, hospital-based study. Data was collected from
records of all patients with Marjolin’s ulcer who were treated in the Unit of Plastic Surgery between 2008
and 2015.
Results: A total number of fifty patients were studied; male to female ratio was 2.8:1. The mean age was
43±12 years and the mean latency period (the mean period between scarring and the diagnosis of Marjolin’s)
was 10.3±5.7 years. Significant association was found between age and latency period (P<0.001). Forty
two percent of patients had duration of illness for 1-5 years before presenting to hospital. Non-healing
ulcers and increasing pain were the main presenting complaints (52% and 26% respectively). Burn scars
were the most frequently reported risk factor (72%). Lower extremities were the commonest site (74%).
The average tumor size was 9±2.5cm and the majority of patients (75.7%) had tumor size of ≥5 cm in
diameter. In addition, regional lymph nodes were clinically palpable in 15(30%) patients, while 11 (22%)
patients had distant metastasis at the time of presentation. Squamous cell carcinoma (84%) was the most
reported histological variant and surgery in the form of wide excision of the ulcer and split-thickness skin
graft or flap coverage was performed in 41(82%) patients.
Conclusion: Clinico-pathological features and risk factors of Marjolin’s ulcers in our case series are
similar to regional reports with characteristic shorter latency period and advanced clinical stages at the time
of presentation. Biopsy of chronic non-healing ulcers is needed to exclude Marjolin’s ulcer and to allow
early diagnosis of the disease.