Marjolin's ulcer revisited – basal cell carcinoma arising from grenade fragments? Case report and review of the literature

Rieger, Ulrich M.; Kalbermatten, Daniel F.; Wettstein, Reto; Heider, Ilonka; Haug, Martin; Pierer, Gerhard

doi:10.1016/j.bjps.2006.05.018

« Previous Next »Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 61, Issue 1 , Pages 65-70, January 2008

Marjolin's ulcer revisited – basal cell carcinoma arising from grenade fragments? Case report and review of the literature

Ulrich M. Rieger
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
- Corresponding author. Tel.: +41 61 265 2525; fax: +41 61 265 7301.
Daniel F. Kalbermatten
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
Reto Wettstein
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
Ilonka Heider
- Department of Pediatric Surgery, University Children's Hospital, 4005 Basel, Switzerland
Martin Haug
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland

Received 18 February 2006; accepted 30 May 2006. published online 01 September 2006.

Summary

Background

Marjolin's ulcer is a rare and often aggressive cutaneous malignancy arising in previously traumatized or chronically inflamed skin.

Method

Case report: A 79-year-old World War II veteran developed basal cell carcinoma (BCC) at the site of a war wound. The tumour developed in relation to several metal grenade fragments. With a disease-free interval of 61 years between injury and onset of complications the patient had one of the longest latency periods of tumour development described so far.

Results

Review of the literature reveals only five cases of relation between grenade fragments and malignancy formation. Presence of foreign bodies has been described as possible aetiology for malignancy development. Explosives and additives contain several mutagenic and tumourigenic substances.

We hypothesize a causal connection between the grenade fragments and the development of BCC. Considering the long period of latency between injury and tumour development we suggest grenade injury with left fragments in soft tissue to be a new origin of Marjolin's ulcer.

Keywords: Marjolin's ulcer, Grenade, Basal cell carcinoma, War injury, Tumourigenic