마르졸랭 궤양의 치료와 임상적 고찰

Abstract

Marjolin's ulcers are malignancies that arise at sites of chronic burn scar wound as well as chronic inflammatory focus such as osteomyelitis, venous stasis, frostbite and urinary fistula, etc. The precise pathogenesis of burn scar carcinoma is not entirely known. However the features that may predispose to malignant transformation of the ulcer include a prolonged healing phase and repetitive trauma. As the rate of malignant transformation is low, there has been no established knowledge regarding clinical characteristics, treatment modality and long-term prognosis. The author experienced and evaluated 10 patients diagnosed as Marjolin's ulcer during 6 years since 1991 and all was ascertained to be squamous cell carcinoma upon histological examiniation. The causative injuries were mostly burn except one case of cart wheel injury and the locations of the lesions were limited to lower extremity except one case of chest. The mean latent period was 36 years and the mean age when diagnosed was 54 years. Seven of 10 patients received wide excisions and skin grafts and 2 received local flap coverages and 1 refused surgery. Two major morbidities were encountered, one underwent above-knee amputation due to recurrence at 8 months postoperatively and the other died of distant metastasis. All clinicians of every specialty are advised to pay attention in the long-term surveillance of all significant scars or areas of chronic inflammation.