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. 1981 May;193(5):598–605. doi: 10.1097/00000658-198105000-00009

A new concept in the management of Marjolin's ulcers.

R F Ryan, M S Litwin, E T Krementz
PMCID: PMC1345126  PMID: 7235765

Abstract

Marjolin's ulcers have a grave prognosis, especially when regional nodes are involved. Recent studies suggest such cancers are in an immunologically privileges sites due to the dense scar tissue. The prognosis has been shown to be much worse for tumors not having a round cell infiltrate prior to surgery, as in Marjolin's ulcers. The use of topical 5-fluorouracil (5-FU) induces a round cell infiltrate. Three case reports of large Marjolin's ulcers are presented which were first treated with topical 5-FU. Radical ablative surgery was avoided in these patients with a successful outcome.

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Selected References

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  1. ARONS M. S., LYNCH J. B., LEWIS S. R., BLOCKER T. G., Jr SCAR TISSUE CARCINOMA. I. A CLINICAL STUDY WITH SPECIAL REFERENCE TO BURN SCAR CARCINOMA. Ann Surg. 1965 Feb;161:170–188. doi: 10.1097/00000658-196502000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Arons M. S., Rodin A. E., Lynch J. B., Lewis S. R., Blocker T. G., Jr Scar tissue carcinoma: II. An experimental study with special reference to burn scar carcinoma. Ann Surg. 1966 Mar;163(3):445–460. doi: 10.1097/00000658-196603000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. CREECH O., Jr, KREMENTZ E. T., RYAN R. F., WINBLAD J. N. Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg. 1958 Oct;148(4):616–632. doi: 10.1097/00000658-195810000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Casson P. R., Gesner B. M., Converse J. M., Rapaport F. T. Immunosuppressive sequelae of thermal injury. Surg Forum. 1968;19:509–511. [PubMed] [Google Scholar]
  5. Castillo J. L., Goldsmith H. S. Burn scar malignancy in a possible depressed immunologic setting. Surg Forum. 1968;19:511–513. [PubMed] [Google Scholar]
  6. Castillo J., Goldsmith H. S. Burn scar carcinoma. CA Cancer J Clin. 1968 May-Jun;18(3):140–142. doi: 10.3322/canjclin.18.3.140. [DOI] [PubMed] [Google Scholar]
  7. Clairmont A. A., Hanna D. C., Gaisford J. C., Richardson G. S. Marjolin's ulcer. Pa Med. 1979 May;82(5):31–33. [PubMed] [Google Scholar]
  8. Crawley W. A., Dellon A. L., Ryan J. J. Does host response determine the prognosis in scar carcinoma? Plast Reconstr Surg. 1978 Sep;62(3):407–414. doi: 10.1097/00006534-197809000-00012. [DOI] [PubMed] [Google Scholar]
  9. Futrell J. W., Myers G. H., Jr The burn scar as an "immunologically privileged site". Surg Forum. 1972;23(0):129–131. [PubMed] [Google Scholar]
  10. GIBLIN T., PICKRELL K., PITTS W., ARMSTRONG D. MALIGNANT DEGENERATION IN BURN SCARS: MARJOLIN'S ULCER. Ann Surg. 1965 Aug;162:291–297. doi: 10.1097/00000658-196508000-00021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. HORTON C. E., CRAWFORD H. H., LOVE H. G., LOEFFLER R. A. The malignant potential of burn scar. Plast Reconstr Surg Transplant Bull. 1958 Oct;22(4):348–353. doi: 10.1097/00006534-195810000-00008. [DOI] [PubMed] [Google Scholar]
  12. Litwin M. S., Ryan R. F., Reed R. J., Krementz E. T. Topical chemotherapy of advanced cutaneous malignancy with 5-Fluorouracil creme. J Surg Oncol. 1971;3(3):351–365. doi: 10.1002/jso.2930030315. [DOI] [PubMed] [Google Scholar]
  13. Litwin M. S., Ryan R. F., Reed R. J., Krementz E. T. Topical chemotherapy of cutaneous malignancy of the head and neck. South Med J. 1969 May;62(5):556–558. doi: 10.1097/00007611-196905000-00013. [DOI] [PubMed] [Google Scholar]
  14. Mansell P. W., Litwin M. S., Ichinose H., Krementz E. T. Delayed hypersensitivity to 5-fluorouracil following topical chemotherapy of cutaneous cancers. Cancer Res. 1975 May;35(5):1288–1294. [PubMed] [Google Scholar]
  15. Novick M., Gard D. A., Hardy S. B., Spira M. Burn scar carcinoma: a review and analysis of 46 cases. J Trauma. 1977 Oct;17(10):809–817. [PubMed] [Google Scholar]
  16. RYAN R. F., WINBLAD J. N., KREMENTZ E. T., CREECH O., Jr Treatment of malignant neoplasms with chemotherapeutic agents utilizing a pump-oxygenator: technics and early results. Bull Tulane Univ Med Fac. 1958 Feb;17(2):133–143. [PubMed] [Google Scholar]
  17. Ryan R. F., Litwin M. S., Krementz E. T. Preoperative immunotherapy: a new concept. J La State Med Soc. 1977 Jun;129(6):151–154. [PubMed] [Google Scholar]
  18. Ryan R. F., Litwin M. S., Reed R. J., Pollock W. J. The use of 5-fluorouracil cream to define suitable donor areas. Plast Reconstr Surg. 1970 Nov;46(5):433–436. doi: 10.1097/00006534-197011000-00003. [DOI] [PubMed] [Google Scholar]
  19. Stromberg B. V., Keiter J. E., Wray R. C., Weeks P. M. Scar carcinoma: prognosis and treatment. South Med J. 1977 Jul;70(7):821–822. doi: 10.1097/00007611-197707000-00017. [DOI] [PubMed] [Google Scholar]

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