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Special Feature
November 1, 2006

Image of the Month—Diagnosis

Arch Surg. 2006;141(11):1144. doi:10.1001/archsurg.141.11.1144

Clinical suspicion led to an incisional biopsy, the specimen of which demonstrated a verrucous squamous cell carcinoma. Inguinal lymph nodes were not palpable. The patient was taken to the operating room for wide local excision and skin grafting. Further histopathologic examination of the excised lesion revealed a moderately differentiated squamous cell carcinoma measuring 11 × 6.5 cm with a depth of 15 mm and clear excisional margins. The patient made an uneventful recovery. The patient was closely followed up and at 15 months remained free of recurrence.

Marjolin ulcer is a malignant change in a long-standing ulcer and/or scar tissue. Commonly, these lesions are treated as chronic ulcers or infections, leading to delayed diagnosis and resulting in the need for more extensive surgery and increased risk of metastasis.1Suspicion of malignant change should be raised with crusting, ulceration of scar tissue, increase in pain or size of the ulcer, and bleeding.2