MEDIX, God. 19 Br. 107/108  •  Pregledni članak  •  Plastična kirurgija HR ENG

Marjolinov ulkus – klinička slika, dijagnostika i liječenjeMarjolin ulcer – clinical manifestations, diagnosis, and therapy

Dubravko Huljev

Marjolinov ulkus je rijetki, invazivni, najčešće dobro diferencirani ulcerozni planocelularni karcinom koji se javlja najčešće u ožiljcima nakon opekline i u kroničnim ranama (dekubitusi, potkoljenični ulkusi). Tumor se dvostruko češće javlja kod muškaraca. Karakterizira ga spori rast uz lokalnu agresivnost i bezbolnost s relativno lošom prognozom i metastaziranjem u limfne čvorove. Etiologija nije potpuno razjašnjena; smatra se da postoji više čimbenika koji dovode do maligne alteracije. Često se ne dijagnosticira na vrijeme i obično se krivo interpretira kao inficirana ulceracija u ožiljku, ili deterioracija i infekcija kronične rane. Kod kronične rane tipični su znaci pojava tumorske mase u kroničnoj rani, promjena mirisa eksudata i promjene u karakteru, volumenu ili izgledu eksudata. Nažalost, dijagnoza se često postavlja prekasno. Kao rezultat zakašnjelog dijagnosticiranja, već oko 30% bolesnika ima metastaze u regionalnim limfnim čvorovima, a oko 13% bolesnika i udaljene metastaze. Liječenje je multidisciplinarno. Još ne postoji konsenzus ni točan protokol liječenja, međutim većina se slaže da je kirurški tretman na prvom mjestu. 

Ključne riječi:
kronične rane; maligna alteracija; Marjolinov ulkus; opekline

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 19 Br. 107/108

Marjolin ulcer is a rare, invasive, usually well differentiated ulcerative squamous cell carcinoma that occurs most often in scars after burns and chronic wounds (decubital ulcers, leg ulcers). The tumor occurs twice as often in men than in women. It is characterized by stunted growth with local aggressiveness and is painless, with relatively poor prognosis and metastasis to the lymph nodes. The etiology is not fully understood, but it is thought to have several factors that lead to malignant transformation. Often the disease is not diagnosed on time and is usually misinterpreted as infected ulcers in scars, or deterioration and infections of chronic wounds. In chronic wounds, the formation of a tumor mass in a chronic wound, odor changes in the exudate and changes in the nature, volume and appearance of exudate are typical. Unfortunately, it is often diagnosed too late. As a result of delayed diagnosis, about 30% of patients have metastases to regional lymph nodes, and approximately 13% of patients have distant metastases. Therapy is multidisciplinary. There is still no consensus or exact protocol of the therapy, but most agree that surgical treatment is the first choice. 

Key words:
burns; chronic wounds; malignant transformation; Marjolin ulcer