From perineal burn scar to Marjolin ulcer: A case report of malignant transformation

Marjolin ulcer (MU) is a rare malignancy that arises in chronic burn scars. The malignant transformation rate of burn scars into MU is less than 2 %. While the extremities are the most common site, MU in the perineal region is exceptionally rare, accounting for only 2.1 % of cases. This case describes a MU that developed in a neglected perineal burn scar after latency of 40 years.

A 45-year-old female presented with a 3-month history of an itchy, painful ulceroproliferative mass in the groin. She had sustained a flame burn at age five. The mass caused discomfort and difficulty in walking. The patient underwent wide local excision and skin grafting. Histopathology confirmed well-differentiated squamous cell carcinoma. The postoperative recovery was uneventful with nearly 100 % graft take.

MU is an aggressive malignancy due to chronic irritation of burn scars, with an average latency of 30-35 years. Proper wound care and early surgical management of burns are essential for prevention. However, in developing countries, limited access to healthcare and societal stigma associated with burns-especially in sensitive areas like the perineum-lead to delayed treatment. This neglect can result in chronic scar contractures and eventual malignant transformation, as observed in this case.

MU in perineal scars is rare, often resulting from delayed treatment due to societal stigma. Prevention should focus on timely burn management, including excision and grafting. Efforts should raise awareness, reduce stigma, and promote early intervention to improve outcomes and prevent complications from chronic wounds.