Remember to Consider Malignancy in Patients with Chronic, Nonhealing Wounds

Jeffrey P. Callen, MD

Such wounds should be biopsied periodically for malignant transformation.

Marjolin described malignant degeneration of a burn scar. Since his report in 1828, others have expanded the use of the term Marjolin ulcer to include malignant transformation of skin ulceration or scarring related to a range of conditions (burns, lupus, traumatic wounds, pressure ulcers, pilonidal sinuses, leprosy, and amputation, among others). Most of the cancers have been squamous cell carcinomas. The frequency of this process is not known.

A recent report from an Italian facility that handles difficult wounds details the authors' experience with malignant processes occurring in chronic ulcers. Over a 10-year period, 1000 patients with chronic ulcers were treated at this center. Thirteen patients developed skin cancers (7 squamous cells, 5 basal cells, and 1 melanoma) during the study period. While some of the patients had rapid changes in lesions that prompted biopsy, others had chronic wounds that had not been biopsied for as long as 9 years.

Citation(s):

Onesti MG et al. Ten years of experience in chronic ulcers and malignant transformation. Int Wound J 2013 Jul 18.