Acute Marjolin's ulcers: a nebulous diagnosis

Area of Science:

• Dermatology
• Oncology
• Pathology

Background:

• Marjolin's ulcers are rare skin cancers typically arising in scarred or chronically inflamed skin.
• They are often squamous cell carcinomas.
• Distinction between acute (≤12 months latency) and chronic (>12 months latency) types exists.

Observation:

• This report details 3 cases of acute Marjolin's ulcers.
• The clinical and histological characteristics, as well as prognosis, between acute and chronic types remain unclear.
• The acute classification may represent a diagnosis based on short latency rather than distinct disease features.

Findings:

• No definitive clinical, histological, or prognostic differences distinguish acute from chronic Marjolin's ulcers.
• The distinction based on latency period may lack clinical utility.
• Malignant degeneration in nonhealing wounds can be rapid, raising questions about pre-existing occult malignancies.

Implications:

• The terminology of acute versus chronic Marjolin's ulcers may not significantly aid clinical understanding or practice.
• The findings reinforce the critical importance of biopsying all nonhealing wounds, regardless of duration, to rule out Marjolin's ulcer.
• Early diagnosis through biopsy is essential for appropriate management of these rare cutaneous malignancies.