The Fate of Chronic Burn Wounds Suspected as Marjolin's Ulcers

Marjolin's ulcer is the malignant transformation of chronic nonhealing ulcers that have developed in burn scars or in any other chronic wound. Development of this malignancy tends to be slow and insidious, but it becomes more aggressive when the Marjolin's ulcer breaks free of the scar. We reviewed 24 cases of patients who complained of chronic burn wounds suspected to be Marjolin's ulcers. Histologically, chronic ulcer and pseudoepitheliomatous hyperplasia were 21%, respectively, and malignancy, including squamous cell carcinoma and leiomyosarcoma, were 58%. The mean latency period was 31.6 +/- 13.0 years, and the majority of lesions occurred in the extremities. Pseudoepitheliomatous hyperplasia in chronic burn wounds, which is difficult to distinguish from squamous cell carcinoma and considered as a transitional state to becoming a malignant tumor, should be treated as a malignancy. An aggressive excision and reconstruction with free tissue transfer or regional flap transposition should be adopted for adequate ablation and definitive coverage, rather than skin graft and regular surveillance.