Introduction Malignant soft tissue tumor found in older patients Epidemiology location dorsum of hand and forearm most common subungual malignancy risk factors primary risk factor is excessive exposure to ultraviolet radiation actinokeratosis chronic osteomyelitis Marjolin's ulcer is a squamous cell carcinoma resulting from chronic draining wounds or burn scars Prognosis metastasis lymph node metastases and high histologic grade confer poor prognosis higher metastatic potential than basal cell carcinoma Presentation Symptoms pain Imaging Radiographs recommended views AP and lateral of affected area findings lytic lesion Treatment Operative wide surgical resection +/-skin graft +/- radiation indications standard traditional treatment adjunctive radiation indications lesions >2cm wide 4mm deep perineural invasion lymph node metastases Mohs microsurgery indications becoming more popular smaller lesions highest cure rate technique lymph node biopsy may be necessary Differential & Groups Treated with wide-resection alone (2) Squamous cell (3) • Adamantinoma • Chordoma • Chondrosarcoma • Parosteal osteosarcoma • ASSUMPTIONS: (1) Older patient is > 40 yrs; (2) assuming no impending fracture (3) assuming no metastatic disease Ibank Location Xray Xray CT B. Scan MRI MRI Histo(1) Case A Finger (1) - histology does not always correspond to clinical case
QUESTIONS 1 of 2 1 2 Previous Next (OBQ10.190) Which of the following best describes a squamous cell carcinoma that develops as a result of chronic drainage from sinus tracts or a result of burn scars? Tested Concept QID: 3288 Type & Select Correct Answer 1 Cushing's ulcer 3% (69/2152) 2 Mooren's ulcer 1% (29/2152) 3 Chancroid ulcer 2% (50/2152) 4 Marjolin's ulcer 87% (1877/2152) 5 Curling's ulcer 5% (118/2152) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK