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Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Am+J+Case+Rep 2016 ; 17 (ä): 111-4 Nephropedia Template TP
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Marjolin?s Ulcer Complicating a Pressure Sore: The Clock is Ticking #MMPMID26898816
Khan K; Giannone AL; Mehrabi E; Khan A; Giannone RE
Am J Case Rep 2016[]; 17 (ä): 111-4 PMID26898816show ga
Patient: Male, 85Final Diagnosis: Marjolin?s ulcer (squamous cell carcinoma)Symptoms: NoneMedication: ?Clinical Procedure: Ulcer excision and split thickness skin graft placementSpecialty: DermatologyObjective:: Rare disease Background:: Malignant degeneration in any chronic wound is termed a Marjolin?s ulcer (MU). The overall metastatic rate of MU is approximately 27.5%. However, the prognosis of MU specific to pressure sores is poor, with a reported metastatic rate of 61%. This is due to insidious, asymptomatic malignant degeneration, a lack of healthcare provider awareness, and, ultimately, delayed management. Case Report:: An 85-year-old white male was noted by his wound-care nurse to have a rapidly developing growth on his lower back over a period of 4 months.There was history of a non-healing, progressive pressure ulcer of the lower back for the past 10 years. On examination, there was a 4×4 cm pressure ulcer of the lower back, with a superimposed 1.5×2 cm growth in the superior region. There was an absence of palpable regional lymphadenopathy.Punch biopsy revealed squamous cell carcinoma consistent with Marjolin?s ulcer. The ulcer underwent excision with wide margins, and a skin graft was placed. Due to the prompt recognition of an abnormality by the patient?s wound-care nurse, metastasis was not evident on imaging. There are no signs of recurrence at 1-year follow-up. Conclusions:: Marjolin?s ulcer has a rapid progression from local disease to widespread metastasis. Therefore, it is essential that wound-care providers are aware of the clinical signs and symptoms of malignant degeneration in chronic wounds.