Spectrum of Malignant Transformation in Marjolins Ulcer: Our Experience of This Rare Phenomenon

Background & Objective: Chronic non healing ulcers or scar undergoing malignant transformation is a rare phenomenon with an estimated incidence of 2%. Though, numerous predisposing factors have been identified, still it is rarely diagnosed and commonly mistaken for a benign condition. The objective of this study was to verify the efficacy of the Fine Needle Aspiration Cytology/ Scrape cytology of chronic non healing ulcers, and its use in the early detection of the malignant transformation, thereby facilitating early management. Methods: A total of 10 cases of chronic non healing ulcer with malignant transformation were included in the study where the initial diagnosis was made on fine needle aspiration cytology/ scrape cytology and later on confirmed on histopathology. Results: Squamous cell carcinoma (7 cases), acantholytic variant of squamous cell carcinoma (1 case), malignant fibrous histiocytoma (1 case) and carcinosarcoma (1 case) was seen. A 100% concordance with histopathology was seen in squamous cell carcinoma cases. Because of the rarity of the case and unusual transformation, high grade pleomorphic spindle cell carcinoma was the cytological diagnosis in case of malignant fibrous histiocytoma. Conclusion: Marjolin ulcer arising out of chronic non healing ulcers can prove to be a precursor of any different kind of malignancies. fine needle aspiration cytology/scrape cytology can be used as a first line diagnostic modality for the early diagnosis as it is a fast and safe method with high rate of accuracy, sensitivity and specificity.