Malignant Transformation in Chronic Stage IV Sacral Pressure Ulcer: A Case of Marjolin Ulcer

A Marjolin ulcer (MU) is a rare type of skin cancer that most commonly occurs in burns and other traumatic scars, and it also may arise in chronic, poorly healing wounds. Typically, MU presents as a squamous cell carcinoma and has a high rate of metastasis resulting in poor prognosis. The mechanism of the aggressive and metastatic potential of MU has not been clearly defined. This malignancy is more common in patients who are elderly or immunocompromised and has also been characterized as a disease of economically developing nations in which health care resources are less abundant and treatment is delayed. Marjolin ulcer is a challenging, although rare, disease. This article presents a case of MU that arose in a chronic sacral pressure ulcer. This was a rare, multifactorial case; the patient's many comorbidities required coordinated efforts by wound care, oncology, and infectious disease specialists. As seen in this case, MU can be insidious and may not become apparent until considerable progression has occurred. This article discusses the multidisciplinary treatment measures undertaken for this patient, the strategies for prophylaxis and early detection of MU, and ultimately, the poor prognosis of MU in such a scenario where diagnosis is delayed.