title: Marjolin's Ulcer Complicating a Pressure Sore: The Clock is Ticking.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of General Surgery, Sinai Hospital of Baltimore, Baltimore, MD, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Khan
authors.affiliation: , Aureus University School of Medicine, Oranjestad, Aruba.
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Giannone
authors.affiliation: Department of Pediatrics, Harbor Hospital, Baltimore, MD, USA.
authors.forename: Erfan
authors.initials: E
authors.lastname: Mehrabi
authors.affiliation: Department of Biology, Hofstra University, Hempstead, NY, USA.
authors.forename: Ayda
authors.initials: A
authors.lastname: Khan
authors.affiliation: , Surgery Private Practice, Anzoátegui, Venezuela.
authors.forename: Roberto E
authors.initials: RE
authors.lastname: Giannone
mesh_terms: D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000601:surgery; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D003668:Pressure Ulcer / Q000150:complications*; D012878:Skin Neoplasms / Q000150:complications* / Q000601:surgery; D013524:Surgical Flaps