diagnosis

Last reviewed 01/2018

diagnosis

Majorlin’s ulcers is a rare condition and generally considered to be high risk SCC’s. The diagnosis may be missed due to several reasons

• complex distracting comorbidities
• clinical inexperience
• non-representative histological sampling
• long latency period e.g. – recent reviews have reported an average time of 29 years

A high degree of suspicion is necessary to make the diagnosis since MU do not always exhibit the typical characteristics of a malignant ulcer:

•  classic features of an everted edge, exophytic growth, and bleeding seen in SCCs may be absent in MU
• an irregular base or margin, excess granulation tissue, and an increase in size despite appropriate treatment are some of the features present in MU
  
  
• malignant transformation may be limited to one edge of the wound while the rest of the wound may heal normally
  
  
• sudden or unexpected changes in an chronic wound should alert about malignant transformation. These changes may be
• new onset of pain
• odour e.g. - a foul smelling discharge
• appearance - a new mass or nodule
• drainage with increased volume, character, or appearance of exudate

Draining lymph node basins should be examined due to the high risk of metastasis (1)

Histological analysis of the lesions is considered as the gold standard for diagnosis.

• false positive and false negative rates are usually less than 2%
• consider obtaining an  incisional or wedge biopsy from any wound that doesn’t heal within three months
• biopsy should be taken from any suspicious areas of the wound, including the edge and centre of the ulcer
• refer patients for biopsy whenever Marjolin’s ulcer is suspected (1)

Reference:

• (1) Choa R, Rayatt S, Mahtani K. Marjolin's ulcer. BMJ. 2015 ;351:h3997.