Post-traumatic acute Marjolin ulcer with a short latency period in a young man: a case report

Marjolin ulcer was first mentioned by Celsius in the first century as a malignant transformation of burn scars, which can be caused by chronic wounds. Marjolin ulcer has been observed to have a latent period of over 10 years and occasionally even 36 years, with a small number of reports of short latent periods. Squamous-cell carcinoma (SCC) is the most common histology and is often characterized by an ulcerated wound around the injury site with raised margins. Marjolin ulcer squamous-cell carcinoma's poor vascularity makes it difficult for it to respond to chemotherapy and radiotherapy. There is lack of data on acute Marjolin ulcer related to post-traumatic wounds in sub-Saharan Africa. We are reporting on a rare case of acute Marjolin ulcer squamous-cell carcinoma of the lower limb that was treated at Ocean Road Cancer Institute in Tanzania. The authors sought to enhance awareness of acute Marjolin ulcer in low- and middle-income countries.

This is a case of a 35-year-old male patient of African origin who was working as an agriculture officer and was involved in a motor bicycle traffic accident 6 years prior at the age of 29 years and sustained facial, chest, and right lower limb injuries, which healed by secondary intention 3 months later. A total of 6 months later, he was diagnosed with invasive squamous-cell carcinoma around the lesions in his right knee. The patient was treated with surgery, chemotherapy, and radiotherapy.

To our knowledge, this is likely to be the first reported case of acute Marjolin ulcer in East Africa and the third in Africa. This highlights the challenges in diagnosing and managing acute Marjolin ulcer in low- and middle-income countries. The short latent period of acute Marjolin ulcer in Africa necessitates genetic and immunological studies. Where possible, deep chronic wounds should be grafted, while unstable scars should be excised and grafted.