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Pooled Oncological Outcomes in Marjolin's Ulcer: A Systematic Review and Meta-Analysis
Saikat Das1, Jerene Mathews2, Aswathy Anilkumar1
1Department of Radiation Oncology, All India Institute of Medical Sciences Bhopal, Bhopal, IND.
Cureus
|July 25, 2026
Summary
Marjolin's ulcer, a rare skin cancer in chronic wounds, often presents as squamous cell carcinoma. This systematic review found a 20% local recurrence rate and 19% nodal metastasis, with 5-year survival at 61%.
Area of Science:
- Dermatology
- Oncology
- Epidemiology
Background:
- Marjolin's ulcer is an aggressive cutaneous malignancy developing in chronic wounds, scars, or burns.
- Existing prognostic and treatment data are fragmented across limited retrospective studies.
- Understanding Marjolin's ulcer epidemiology and outcomes is crucial for patient management.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of Marjolin's ulcer.
- To consolidate prognostic and treatment data from existing literature.
- To estimate pooled outcomes including recurrence, metastasis, and survival rates.
Main Methods:
- Systematic review and meta-analysis registered with PROSPERO and adhering to PRISMA guidelines.
- Searched PubMed, EMBASE, Scopus, Cochrane Library, and ScienceDirect for relevant case series and cohort studies (≥10 patients).
- Pooled proportions using random-effects models; compared treatment arms using log risk ratios; assessed bias with JBI checklist.
Main Results:
- Included 51 studies with 2,388 patients; 95.7% were squamous cell carcinoma, predominantly on the lower limb (58.9%) after a median latency of 29.5 years.
- Pooled local recurrence rate: 20% (95% CI 16%-24%); pooled regional nodal metastasis rate: 19% (95% CI 15%-24%).
- Pooled five-year overall survival: 61% (95% CI 49%-72%); adjuvant radiotherapy showed no significant effect on local recurrence.
Conclusions:
- Marjolin's ulcer is primarily squamous cell carcinoma with significant recurrence and metastasis rates.
- Evidence certainty is low to very low, highlighting the need for high-quality research.
- Wide local excision with clear margins, following oncological principles, remains the standard management.