A Rare Case Report of Marjolin Ulcer of the Lower Limb Managed with
Amputation
Dr Suraj KC1*, Dr Rakesh Kumar
Gupta1, Dr Abhijeet Kumar1, Dr
Bhawani Khanal1, Dr Samiksha
Lamichhane2 ,Dr Sanjok Bartaulla1 ,
Dr Raghav jindal1, Dr Injmamul Haque
Raki1
* Corresponding Author: Dr Suraj KC
Department of General Surgery, BPKIHS, Dharan
kcsuraj1122@gmail.com
Dr Rakesh Kumar Gupta:
Department of General Surgery, BPKIHS, Dharan
rakesh154@yahoo.co.in
Dr Abhijet Kumar:
Department of General Surgery, BPKIHS, Dharan
abhijeetkr639@gmail.com
Dr Bhawani Khanal:
Department of General Surgery, BPKIHS, Dharan
itsmebhawanikhanal@gmail.com
Dr Samiksha Lamichhane:
Department of Radiodiagnosis and imaging, BPKIHS, Dharan
slamichhane215@gmail.com
Dr. Rahul Shrestha:
Department of General Surgery, BPKIHS, Dharan
Shrestharahul1522@gmail.com
Dr. Sanjok Bartaulla:
Department of General Surgery, BPKIHS, Dharan
sanjok.bartaula.sb@gmail.com
Dr Injmamul Haque Raki:
Department of General Surgery, BPKIHS, Dharan
Injmamulhaqueraki@gmail.com
Dr Raghav Jindal
Department of General Surgery, BPKIHS, Dharan
drraghavjindal@gmail.com
Abstract:
Marjolin ulcers are known to develop on chronic wounds and ulcers.
Biopsy is indicated for chronically suspicious ulcers with no signs of
healing. Metastatic workup is necessary before considering any type of
surgery. Amputation, as in our case, is indicated when wide local
excision or Mohs surgery cannot be performed. Chemotherapy and
radiotherapy are reserved for advanced disease and patients who are not
fit for surgery.
Introduction:
Post-burn wounds or scars have the potential to become chronic and may
progress into Marjolin ulcers. While rare, it is important to be
vigilant with suspicious wounds that do not show signs of healing. We
present a case of a 55-year-old woman who developed a non-healing ulcer
on the back of her right foot, covering the Achilles tendon, which
ultimately required below knee amputation.
Case Report:
A 55-year-old woman with a history of hypertension and a flame burn on
her right foot two years ago presented to the General Surgery Outpatient
Department with a non-healing ulcer and foul-smelling discharge. The
ulcer had grown from the size of a coin to 5cm x 5cm, located on the
posterior aspect of her right ankle. The ulcer was painless with minimal
bleeding, and she had intact distal neurovascular function. She denied
any respiratory symptoms, chest pain, cough, or similar ulcers elsewhere
on her body. Physical examination and vitals were stable. Upon local
examination there was 5 x 5cm ulcer over the lateral malleolus and mass
on the posterior aspect of the right Achilles tendon ( figure 1).
Routine tests were normal, and a biopsy revealed squamous cell
carcinoma. Imaging showed no signs of metastasis. The patient underwent
a right below knee amputation, and the postoperative period was
uneventful (figure2). She was discharged on the 4th post-operative day.
The margins were negative for squamous cell carcinoma. On a follow up,
stump was healthy, and she was referred for a prosthesis and
rehabilitation. Regular follow-ups were advised under the General
Surgery Department.\sout