Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

STUDY DESIGN: Case report.

OBJECTIVE: Report of an unusual case, where a Marjolin's ulcer that developed 2.5 years after surgical excision and successful closure.

SETTING: Department of Plastic and Reconstructive Surgery and Burn Unit and the Clinic for Spinal Cord Injuries, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

METHODS AND RESULTS: A 22-year-old man sustained a fracture with luxation of the 5th and 6th cervical vertebrae and loss of sensory and motor function after a diving accident (complete C8 lesion). During initial hospitalization, he developed a sacral ulcer, which more or less persisted for 38 years, despite several attempts of surgical and conservative treatment. At this time, the ulcer was finally excised and the wound closed successfully. Two and a half years later, however, the ulcer recurred. Biopsies showed squamous cell carcinoma and computed tomography, and magnetic resonance imaging scans revealed a soft tissue process over the sacral and coccygeal bones and massive destruction of these bony structures. The patient died 11 months later, despite surgical and radiation treatment.

CONCLUSION: The present case is unusual because, in spite of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies in longstanding chronic ulcers to procure early diagnosis and treatment.