Skin Cancer Squamous Cell Carcinoma of the Arms and Legs

Marjolin's ulcer is a term that refers to malignant changes occurring in chronic ulcers and wounds of the skin, sinuses and previous burns. Most lesions are reported in burns. The majority of these lesions are found on the extremities. Development times for burn scar carcinomas of more than 30 years have been noted. Different cultures appear to have markedly different susceptibilities to Marjolin's ulcer. Japan, Northern India, and China report high incidences of burn-scar carcinoma.

SCCs that occur at sites of chronic inflammation are more aggressive than those that develop from actinic keratoses or Bowen's disease. Their appearance is masked by inflamed hypertrophic tissue. The overall metastatic rate is greater than 40%. The incidence of regional lymph node involvement from burn-scar carcinoma is approximately 35%. The 5-year survival rate for lower extremity lesions is approximately 30%.

Because of the focal nature of malignant change in burn scars, excisional biopsy should be performed. Punch biopsies may be negative.

Wide local excision has proven unreliable for grade II and grade III disease; amputation and prophylactic node irradiation is recommended. Wide local excision is reserved only for very small lesions that can be radically excised or for grade I lesions.