Giant exophytic Marjolin's ulcer of the lower leg after the gunshot wound: Case report

Abstract

Introduction. Marjolin's ulcer is a skin malignancy that occurs on a scar or chronic wound. It most commonly occurs on a burn scar. Squamous cell carcinoma is the most common type of tumor, in more than 90% of cases. The rate of this rare malignant transformation is 1-2%. Marjolin's ulcer is more aggressive than other skin cancers. Wide excision is the treatment of choice. Recurrences are common. The aim of this article is to present a large exophytic carcinoma of the lower leg as a rare form of this tumor according to the size and type. The result of the radical surgery with reconstruction is also presented. Case report. Male patient, aged 52 years was presented by large exophitic tumor on the left lower leg. Tumor was located at the site of the previous gunshot injury. Latent period was 22 years. Tumor size was 14x12cm. Wide excision was performed (2-cm surgical margin) including the deep fascia and the defect was closed by split thickness skin graft from the opposite thigh. Histology showed well differentiated squamous cell carcinoma. There were no regional or distant metastases. One year after surgery there was no recurrence of the tumor. Conclusion. Early diagnosis of Marjolin's ulcer and wide excision are mandatory. Surgical margins for excision should be 2 cm and excision should include deep fascia. Multiple and repeated biopsies of the chronic wounds are advised. There is no consensus on staging of the Marjolin's ulcer and lymph node dissection.