Thread by @guerreroespejo

An 86-YO ♂️, injury on his L leg 47 years prior, several debridements, skin grafts, & vein stripping procedures: chronic bilateral leg progressive ulcers.

Superficial🧫: multiple organisms including E. coli & coagulase➖Staphylococcus.
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#internalmedicine #IDtwitter

Skin biopsy🔬: bilateral invasive squamous cell carcinomas.

BILATERAL INVASIVE SQUAMOUS CELL CARCINOMAS (MARJOLIN ULCERS)
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#dermatology #dermpath
doi.org/10.1093/cid/ci…

The mean time period between development of a wound to malignancy is 30–35 years.

The most common malignancies seen in Marjolin ulcers are squamous cell carcinomas, but basal cell carcinomas and melanomas have been reported.
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Marjolin ulcers are a complication of burn scars, chronic wound including osteomyelitic fistulae and venous stasis ulcers.
These lesions can be difficult to distinguish from infection clinically, and definitive diagnosis is achieved with skin biopsy.
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The treatment of Marjolin ulcers usually involves surgical intervention

The 5-year survival rate in Marjolin ulcers has been reported to be between 40% and 69%.

Most lesions recur within 3 years.
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doi.org/10.1093/cid/ci…

Marjolin ulcers can have a similar clinical presentation to infection and can be a complication of chronic infection, such as osteomyelitis.

Appropriate evaluation of chronic nonhealing ulcers should include skin biopsies to assess for Marjolin ulcer.
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