Analysis of factors affecting chronic ulcers of scalp transforming into Marjolin's Ulcer-A single center experience.

BACKGROUND The Marjolin's ulcer is a rare malignant lesion, which is characterized by primary, chronic wound initially and formation of cancer after a certain incubation period eventually. Though few reports or a small case series about Marjolin's ulcer on the scalp have been published, special risk factors are still unknown about the formation of malignancy on the scalp with chronic ulcer. The aim of the article is to explore the risk factors. METHODS Seventy-four patients with the chronic ulcer were included in the study. In between, the chronic ulcer transformed into the Marjolin's ulcer on the scalp (tumor group) in forty-two cases, while the chronic ulcer did not transform into the Marjolin's ulcer on the scalp (tumor-free group) in thirty-two cases as controlled group. We made a comparative study between the above two groups so as to find which risk factors were critical for cancer development. RESULTS In tumor group: lymph node dissection was implemented if the lymph node metastasis was found. Artificial dura was used in eight cases when the dura was removed. Seven cases died. Two patients are currently undergoing follow-up. Other cases were without tumor detection from 1 to 7 years. When the comparative study between the above two groups, there is statistical significance about the influential factor: scar adherence to the skull (F=5.602 P=0.018). CONCLUSIONS Scar adherence to the skull may be the most critical risk factor for cancer development for the scalp with chronic ulcer.