Case and Research Letters
Marjolin Ulcer: A Report of 2 Cases of Squamous Cell Carcinoma Arising From Posttraumatic Soft-Tissue Scarring
Úlcera de majorlin: 2 casos de carcinoma escamoso sobre cicatriz por trauma en tejidos blandos
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"apellidos" => "Alfageme Roldán" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019301899" "doi" => "10.1016/j.ad.2018.06.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731019301899?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019303555?idApp=UINPBA000044" "url" => "/15782190/0000011100000001/v2_202004200619/S1578219019303555/v2_202004200619/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Marjolin Ulcer: A Report of 2 Cases of Squamous Cell Carcinoma Arising From Posttraumatic Soft-Tissue Scarring" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "81" "paginaFinal" => "83" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V.L. Dávila Osorio, L. Méndez Gaviria, J.R. Amador Patarroyo, M.I. González" "autores" => array:4 [ 0 => array:4 [ "nombre" => "V.L." "apellidos" => "Dávila Osorio" "email" => array:1 [ 0 => "dra.daviladermatologa@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Méndez Gaviria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.R." "apellidos" => "Amador Patarroyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M.I." "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Patología, Hospital Militar Central, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlcera de majorlin: 2 casos de carcinoma escamoso sobre cicatriz por trauma en tejidos blandos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1374 "Ancho" => 1505 "Tamanyo" => 422151 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Ulcerated verrucous tumor on the right forearm. B, Well-differentiated infiltrating squamous cell carcinoma (hematoxylin-eosin, original magnification ×10). C, Mitosis, nuclear pleomorphism (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">To the Editor:</span></p><p id="par0010" class="elsevierStylePara elsevierViewall">Marjolin ulcer is an invasive neoplasm that arises from chronic wounds of any etiology, including traumatic wounds, chronic ulcers, and partial or total skin grafts.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Squamous cell carcinoma, although rare, is the most frequently produced neoplasm.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Here, we present 2 representative cases.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Descriptions</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 56-year-old man with a history of soft-tissue trauma caused by crushing of the left leg, for which he had undergone allograft reconstruction 38 years earlier. He was seen for a progressively enlarging verrucous, ulcerated lesion on the left leg that had appeared 1 year earlier (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A biopsy was performed on suspicion of malignancy and revealed an infiltrating squamous cell carcinoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and C). Imaging studies showed bone infiltration, which necessitated amputation of the affected limb.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case 2</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 51-year-old man with a history of soft-tissue trauma with circumferential compromise and tissue avulsion caused by a crush injury received in a traffic accident 30 years earlier. He was seen for a progressively enlarging verrucous, ulcerated lesion, located on the scar on his right forearm that had appeared 1 year earlier (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). A biopsy was performed on suspicion of malignancy and revealed an infiltrating squamous cell carcinoma (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B and C). The patient underwent chemotherapy and radiation therapy, after which tumor recurrence necessitated amputation of the affected limb.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Squamous cell carcinoma is the second most common cutaneous neoplasm after basal cell carcinoma. This tumor type can occur de novo or can arise from precancerous lesions or from lesions caused by prior trauma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Tumors that arise from chronic wounds, including chronic ulcers, are known as Marjolin ulcers, and have an estimated incidence of 1.3%–2.2%, which increases with the chronicity of the pre-existing lesion.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Development of Marjolin ulcer has been reported up to 65 years after the appearance of the initial lesion, although the mean latency is approximately 40 years.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In our 2 cases the mean latency to lesion appearance was 34 years after the initial trauma. The inflammatory environment of ulcers (large amounts of cytotoxic products derived from macrophage activity within the wound, cells with a high mitotic capacity, an ischemic environment, and poor lymphatic drainage) favors carcinogenesis and the formation of tumors such as Marjolin ulcer.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,5</span></a> In cases of clinical suspicion of this tumor type histology should be performed to confirm the diagnosis. Histology reveals findings compatible with squamous cell carcinoma. The degree of tumor differentiation is the primary long-term prognostic factor; greater degrees of differentiation, ulceration, and dermal infiltration by tumor cells are associated with a higher rate of recurrence.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Tumor staging should be performed to evaluate lymph node involvement distant from the tumor and to determine the appropriate therapeutic approach. Surgery is the treatment of choice, with reported 2-year survival rates of 66%–80%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Adjuvant treatments such as radiotherapy or chemotherapy may be useful in patients with inoperable tumors or those who refuse surgery.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Lesion chronicity, clinical findings, and clinical-pathological correlation are key to the diagnosis of Marjolin ulcer. A high index of suspicion is necessary to establish an early diagnosis and thereby provide patients with timely treatment.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflict of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Case Descriptions" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2" ] ] ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-28" "fechaAceptado" => "2018-06-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Dávila Osorio VL, Méndez Gaviria L, Amador Patarroyo JR, González MI. Úlcera de majorlin: 2 casos de carcinoma escamoso sobre cicatriz por trauma en tejidos blandos. Actas Dermosifiliogr. 2020;111:81–82.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1293 "Ancho" => 1505 "Tamanyo" => 345198 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Ulcerated verrucous tumor on the left leg. B, Nests of squamous cells infiltrating the dermis (hematoxylin-eosin, original magnification ×10). C, Nuclear pleomorphism (hematoxylin-eosin, original magnification ×40).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1374 "Ancho" => 1505 "Tamanyo" => 422151 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Ulcerated verrucous tumor on the right forearm. B, Well-differentiated infiltrating squamous cell carcinoma (hematoxylin-eosin, original magnification ×10). C, Mitosis, nuclear pleomorphism (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ten years of experience in chronic ulcers and malignant transformation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.G. Onesti" 1 => "P. Fino" 2 => "P. Fioramonti" 3 => "V. Amorosi" 4 => "N. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 7 | 13 |
| 2024 Octubre | 94 | 38 | 132 |
| 2024 Septiembre | 106 | 28 | 134 |
| 2024 Agosto | 138 | 56 | 194 |
| 2024 Julio | 92 | 38 | 130 |
| 2024 Junio | 95 | 43 | 138 |
| 2024 Mayo | 106 | 38 | 144 |
| 2024 Abril | 84 | 31 | 115 |
| 2024 Marzo | 87 | 30 | 117 |
| 2024 Febrero | 65 | 29 | 94 |
| 2024 Enero | 88 | 38 | 126 |
| 2023 Diciembre | 81 | 15 | 96 |
| 2023 Noviembre | 141 | 29 | 170 |
| 2023 Octubre | 108 | 35 | 143 |
| 2023 Septiembre | 100 | 34 | 134 |
| 2023 Agosto | 70 | 21 | 91 |
| 2023 Julio | 109 | 40 | 149 |
| 2023 Junio | 70 | 32 | 102 |
| 2023 Mayo | 124 | 47 | 171 |
| 2023 Abril | 91 | 35 | 126 |
| 2023 Marzo | 111 | 36 | 147 |
| 2023 Febrero | 87 | 34 | 121 |
| 2023 Enero | 76 | 36 | 112 |
| 2022 Diciembre | 82 | 57 | 139 |
| 2022 Noviembre | 70 | 38 | 108 |
| 2022 Octubre | 81 | 35 | 116 |
| 2022 Septiembre | 89 | 41 | 130 |
| 2022 Agosto | 80 | 39 | 119 |
| 2022 Julio | 68 | 41 | 109 |
| 2022 Junio | 49 | 29 | 78 |
| 2022 Mayo | 84 | 62 | 146 |
| 2022 Abril | 116 | 49 | 165 |
| 2022 Marzo | 96 | 72 | 168 |
| 2022 Febrero | 98 | 36 | 134 |
| 2022 Enero | 107 | 40 | 147 |
| 2021 Diciembre | 67 | 47 | 114 |
| 2021 Noviembre | 78 | 41 | 119 |
| 2021 Octubre | 84 | 57 | 141 |
| 2021 Septiembre | 64 | 25 | 89 |
| 2021 Agosto | 66 | 21 | 87 |
| 2021 Julio | 79 | 21 | 100 |
| 2021 Junio | 49 | 29 | 78 |
| 2021 Mayo | 45 | 49 | 94 |
| 2021 Abril | 278 | 50 | 328 |
| 2021 Marzo | 168 | 23 | 191 |
| 2021 Febrero | 93 | 26 | 119 |
| 2021 Enero | 57 | 17 | 74 |
| 2020 Diciembre | 60 | 14 | 74 |
| 2020 Noviembre | 59 | 14 | 73 |
| 2020 Octubre | 43 | 17 | 60 |
| 2020 Septiembre | 37 | 15 | 52 |
| 2020 Agosto | 32 | 16 | 48 |
| 2020 Julio | 21 | 14 | 35 |
| 2020 Junio | 16 | 16 | 32 |
| 2020 Mayo | 61 | 13 | 74 |
| 2020 Abril | 40 | 21 | 61 |
| 2020 Marzo | 24 | 12 | 36 |
| 2020 Febrero | 2 | 2 | 4 |
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