Advanced Marjolin`s ulcer of the scalp Radisavljevic M, Stefanovic I, Stojanovic N, Novak V, Igic A, Jeremic S Clinical Center of Nis, Department of Neurosurgery

​A 45-year-old male was admitted to our clinic with a 1 month history of ulcerative lesion arising from the scalp, after a minor head trauma. His medical history revealed that he had a burn injury caused by open fire, when he was only 3 years old. The wound heled by scarring as in secundary intention. The wound had remained unchanged until he had minor head trauma, which resulted in an ulcerative lesion in the midle of the previous scar, about 3 cm in diameter. He self treated for a few week; however, since the lesion continued to increase in size he went to see a local doctor, and soon after that he was sent to our outpatient clinic.

Biochemical analyses were normal Biochemical analyses were normal. The blood analysis revealed incresed ESR, and leucocytosis of 14x 10 9. The x-ray examination of the chest was normal, as well as the ultrasound of the abdomen. From the surface of the lesion we isolated Staphylococcus aureus, and antibiotic was administered according to the antibiogram findings.

​Tumor was excised with the 2cm margin of normal skin and the infiltrated bone margines were removed. ​Tumor was excised from underlying dura, and dura itself was not infiltrated by it. ​Bone defect was covered with Titanium mesh with screw fixation, and skin defect was reconstructed with rotation skin flap from frontoparietal area, and newly created defect was reconstructed with few skin flaps with partial tickness (Thiersch type)

​The term ``Marjolin`s ulcer`` is used to describe the formation of carcinoma in the scar tissue of chronic ulcers often with an aggressive course. Jean Nicholas Marjolin was the first to describe a villous lesion in post burned scar tissue (Marjolin JN. Ulcere In: Adelon NP, ed. Dictionare de medicine, vol 21. Paris: Becher; 1828: 31-50). ​The malignant potential of these ulcers was noted by Dupuytren two years later , in 1850 Robert Smith also recognized its malignant potential. DaCosta was the first to use the term Marjolin`s ulcer in 1903 The majority of reported cases in the literature are squamous cell carcinoma but other types have also been reported such as basal cell carcinoma and melanoma

The featurs of the ulcer that are suggestive of malignant alteration include chronic ulcer duration longer than three months, excessive granulation tissue beyond margins, everted wound edges, recurrent ulceration after the appropriate treatment, pain, ulcers that increase in size The recurrence rate is high due to the aggressive nature of the tumor and the most important prognostic factors are the histopathological type, the stage of the lesion and the presence of metastases at the time of the diagnosis An early diagnosis and prompt and wide surgical resection is the recommended treatment of Marjolin`s ulcers, especially for the lesions located on the scalp, because the neighboring structures and the brain tissue can be involved in tumor spreading in early phases. Reconstructive techniques are recommended. The resection of the local lymphatic nodes is recommended only when they are palpable.