Marjolins Ulcer

بةيانيتان باش

Case presentation

–Marjolin,s ulcer

• complaining of non-healing ulcer in the lower Rt. leg of 2 years duration.

• Saeedia muhamad shukry 25 years old typist lady from Sulaimani, presents to me on 20th nov. 2003,

• The condition started 2 years ago after revision of the scare of old burn (15 years old), a small area remain uncovered,

• became larger gradually over the last 2 years.

• To became as large as a small apple.

• There was a serous discharge for the lesion, which was neither painful, nor ltchy

• . She thought that it’s due to disruption of the sutune line of the last revision.

•On local examination;

There was large round ulcer about 10 cm in diameter, 3 mm depth in

thecentre&5 mm hieght at the margin

which was regular, surround by a scared skin with everted margin,

dirty & sloughing floor• ,

•Non tender, of same temp. as surrounding the base in indurated

–No regional LNs

•arranged for wedge biopsy, which revealed Sq. C. C.

Few facts about Marjolins ulcer• Marjolin,s ulcer is an eponym reserved for

a squamous carcinoma which arises in a long-standing benign ulcer or scar.

• The most common ulcer to become malignant is a long standing venous ulcer

• The scar that is most often associated with malignant change is the scar of an old burn.

• These carcinomata have characteristics similar to those of the ordinary squamous carcinoma except that they may not be so florid. Their edge is not always raised and everted, and other features may be masked by the pre-existing chronic ulceration or scarring. Unusual nodules or changes in a chronic ulcer or a scar should be viewed with suspicion

.PainlessSlow growing

No LN metastasin

• This type of carcinoma is not so invasive, slower growing and slightly less malignant than the spontaneous squamous carcinoma, but must be treated as vigorously

DDX

• A carcinomatous ulcer has everted edges which to the palpating fingers feel hard.

• A Carcinomatous Ulcer (epithelioma, squamous-cell carcinoma of skin) can hardly be mistaken, especially after the evasion and the induration of the edge of the ulcer have been observed mollucsum sebaceum may be confused with epithelioma.

سوثاس بؤ طوَي� طرتنتان

Bo hatwan• Cholesterol-lowering strategies, including a low saturated-fat diet,• weight loss, • physical activity and• medication, all focus on reaching a particular LDL goal.. • You can modify some risk factors, such as• smoking and• high blood pressure, • Having even one risk factor increases your chance of developing

heart disease at some time. • The good news is that measures you take to reduce your LDL

cholesterol will also help reduce your blood pressure and weight and control your diabetes, if you have it.