Aggressive, Metastatic Squamous Cell Carcinoma After a 46-Year-Old History of Chronic Osteomyelitis and Local Infectious Complications: A Case Report

Roberto Manfredi, Sergio Sabbatani, Filippo Trapani, Calogero Alfonso, Massimo Laus



Marjolin’s ulcer is a squamous cell carcinoma (SCC) arising from any site of established chronic inflammation, especially with presence of scar tissue.

An emblematic case report of locally disseminated SCC arising from a chronic osteomyelitis of the left leg complicated by recurring soft tissue infections lasting since 46 years is presented and discussed according to the available international literature evidence. Concurrent diseases, supporting factors, clinical and histopathological presentation, differential diagnosis, and time and mode of management of this potentially functional- and life-threatening pathological condition are reviewed and discussed to offer a theme to daily clinical care.


Carcinoma, Squamous Cell; Osteomyelitis; Infection; Local; Surgery; Marjolin’s disease

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  • Wallingford SC, Olsen CM, Plasmeijer E, et al. Skin cancer arising in scars: a systematic review. Dermatol Surg 2011; 37: 1239-44;
  • Mercuri SR, Brianti P, Rizzo N, et al. Basal cell carcinoma in post-traumatic scar successfully treated with thulium laser and photodynamic therapy. G Ital Dermatol Venereol 2018; (Mar 6) (Epub ahead of print)
  • Esther RJ, Lamps L, Schwartz HS. Marjolin’s ulcers: secondary carcinomas in chronic wounds. J South Orthop Assoc 1999; 8: 181-7
  • Phillips TJ, Salman SM, Chawan J, et al. Burn scar carcinoma. Diagnosis and management. Dermatol Surg 1998; 24: 561-5;;
  • Simmons MA, Edwards JM, Nigam A. Marjolin’s ulcer presenting in the neck. J Laryngol Otol 2000; 114: 980-2;
  • Steffen C. The man behind the eponym. Jean-Nicolas Marjolin. Am J Dermatopathol 1984; 6: 163-5;
  • Chong AJ, Klein MB. Images in clinical medicine. Marjolin’s ulcer. N Engl J Med 2005; 352: e9;
  • Bartle EJ, Sum JH, Wanh XW, et al. Cancers arising from burn areas. A literature review of twenty-one cases. J Burn Care Rehabil 1990; 11: 46-9;
  • Lifeso RM, Bull CA. Squamous cell carcinoma of the extremities. Cancer 1985; 55: 2862-7;<2862::AID-CNCR2820551226>3.0.CO;2-H
  • Fleming MD, Hunt JL, Purdue GF, et al. Marjolin’s ulcer: a review and re-evaluation of a difficult problem. J Burn Care Rehabil 1990; 11: 460-9;
  • Smidt LS, Smidt LF, Chedid MB, et al. Radical surgical treatment for Marjolin ulcer occurring after chronic osteomyelitis. South Med J 2005; 98: 1053;
  • Giunti A, Laus M. Tumori maligni in osteomielite cronica. Presentazione di 39 casi, 26 controllati a distanza. Giornale Italiano di Ortopedia e Traumatologia 1978; 4: 167-77
  • Campanacci M. Carcinomas and sarcomas on chronic osteomyelitis. In: Campanacci M (Ed.). Bone and soft tissues tumors. Bologna: Springer-Verlag – Gaggi, 1990, 661-664;
  • Manfredi R, Sabbatani S, Nanetti A, et al. A puzzling microbiological and clinical discrepancy in the management of acute, severe skin-soft tissue and joint staphylococcal infection. In vitro antimicrobial susceptibility to glycopeptides, versus in vivo clinical efficacy of linezolid alone. Infez Med 2006; 14: 157-64
  • Bostwick, J 3rd, Pendrgrast WJ Jr, Vasconez LO. Marjolin’s ulcer: an immunologically privileged tumor? Plast Reconstr Surg 1976; 57: 66-9;
  • Cruickshank AH, McConnell EM, Miller DG. Malignancy in scars, chronic ulcers and sinuses. J Clin Pathol 1963; 16: 573-80;
  • Trabucchi E, Pace M, Gabrielli L, et al. The trophic venous ulcer. The physiopathological, microbiological and pharmacological aspects. Minerva Cardioangiol 1994; 42: 43-50
  • Hill BB, Sloan DA, Lee EY, et al. Marjolin’s ulcer of the foot caused by nonburn trauma. South Med J 1996; 89: 707-10;
  • Paredes F. Marjolin ulcer. Acta Med Port 1998; 11: 185-7
  • Barr LH, Menard JW. Marjolin’s ulcer. The LSU experience. Cancer 1983; 52: 173-5;<173::AID-CNCR2820520131>3.0.CO;2-6
  • Ames FC, Jickey RC. Squamous cell carcinoma of the skin of the extremities. Int Adv Surg Oncol 1980; 3: 179-99
  • Novick M, Gard DA, Hardy SB, et al. Burn scar carcinoma: a review and analysis of 46 cases. J Trauma 1977; 17: 809-17;


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