Malignant transformation of chronic ulcers (Marjolin’s ulcers): an emerging at-risk population

Children born with neural tube defects (NTDs) have significant high morbidity and mortality rates. Myelomeningocele is a form of NTD that causes severe neurological deficits. Other serious complications can arise from poor adaptation to these resulting deficits. Preventive measures and proper management are essential to improve healthcare outcomes, and to reduce health and financial burdens on both individuals and society. A 30-year-old Kenyan gentleman presented to the hospital with chronic, painful, non-healing gluteal ulcers. He had a background history of congenital myelomeningocele, with resulting paraplegia and incontinence. A biopsy of the lesion showed areas of squamous cell carcinoma (Marjolin’s ulcers). This was believed to have resulted from life-long abnormal mobility techniques, leading to chronic ulceration and inflammation of the gluteal region; the patient used his arms to slide his bottom across the floor, as he could not afford a wheelchair. His management plan included a wide excision of the tumour followed by skin grafting. A loop colostomy had to be performed prior to surgery to allow for proper wound healing, counselling and follow-up were also required. Chronic inflammation, chronic wounds and scars are all predisposing factors in the development of Marjolin’s ulcers. Marjolin’s ulcers are an aggressive form of squamous cell carcinoma that requires immediate surgical intervention. The incidence of Marjolin’s ulcers is increasing in Africa due to an increase in the survival rate of babies born with NTDs; thus, health education for patients with regard to ulcer prevention and treatment should be advocated by healthcare professionals.