Marjolin's Ulcer in Patients With Anogenital Lichen Planus: A Systematic Review

Anogenital lichen planus (ALP) is a chronic inflammatory condition associated with significant morbidity and a potential risk of cutaneous squamous cell carcinoma (cSCC), specifically Marjolin ulcer (MU), a rare, but aggressive, life-threatening complication. This systematic review aimed to describe the clinical characteristics of patients developing MU within ALP and its treatment outcomes. MEDLINE and Embase (inception-November 2024) were searched, identifying studies reporting MU or squamous dysplasia arising within ALP lesions. Thirty-two studies (n = 176 cases) were analyzed, including cohort studies, case series, and reports, and a descriptive analysis was performed. Patients had a mean age of 63.9 years, with 77.3% female. ALP lesions were most commonly vulval (72.2%) in females and penile (22.2%) in males. MU or cSCC precursor prevalence in ALP cohorts ranged from 0.9% to 4.2%. Human papillomavirus was rarely detected (8.4%), suggesting other mechanisms underlying MU development. The mean ALP duration prior to squamous dysplasia was 47.5 months. Metastases were present in 45.7% of cases that reported this outcome. MU treatment primarily involved surgical excision, with recurrence in 32.9% of cases and mortality in 21.1%. Poor disease control, erosive morphology, and long-standing lesions were associated with higher malignancy risk. Overall, this review highlights the malignant potential of ALP and underscores the importance of early detection and multidisciplinary care. Routine anogenital examinations, timely biopsies of suspicious lesions, and aggressive management of ALP may improve outcomes. Further research is needed to elucidate the mechanisms underlying MU development and optimize treatment strategies for this rare but morbid complication.