Metastatic Marjolin Ulcers: A Systematic Review and Single-center Experience

Background: Marjolin ulcers (MUs) are rare, aggressive cutaneous malignancies that arise from previously injured or chronically inflamed skin. MUs have a poorer prognosis than other types of skin malignancies, with higher nodal metastases and recurrence rates. Although surgical resection remains the primary treatment modality, the management and outcomes of patients with metastatic disease are not well characterized. We reviewed literature on treatment strategies for metastatic MUs and report our institutional experience so as to stimulate interest in this difficult-to-treat entity. Methods: A systematic review on metastatic MUs following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the English-language literature. An institutional case series is reported to capture the experience of a rural African hospital. Results: Of 180 publications reviewed, 9 studies with 129 patients, with a mean age of 50.3 years, were included in the study. Burn scars were the most common precursor (54%), with squamous cell carcinoma accounting for 97% of cases. Metastases involved the regional lymph nodes, lungs, and liver. Initial treatment included wide local excision or amputation, with or without adjuvant radiotherapy. Survival data were sparse. Our institutional cohort of 11 patients showed similar patterns of metastases. Conclusions: This review did not identify any effective treatment for metastatic MUs. The current management strategies are largely determined by institutional resource settings, but remain essentially palliative in their approach, highlighting the need for a standardized approach to achieve optimal patient outcomes.