Answer: D. Squamous cell carcinoma is the most common type

Explanation

Marjolin ulcer refers to the development of a malignancy, most commonly squamous cell carcinoma (SCC), within a long-standing scar, burn scar, sinus tract, or chronic ulcer. Basal cell carcinoma may also occur but is much less common.

Scar tissue is relatively avascular and lacks normal lymphatic channels. As a result, these tumors typically exhibit slow growth initially. However, once the tumor extends into surrounding normal tissue, lymphatic spread and metastasis may occur.

Marjolin ulcers are classically associated with chronic burn scars but may arise in any long-standing ulcer, including venous ulcers.

Why other options are incorrect

• A. Lymphatic spread is common: False. Scar tissue lacks lymphatics; lymphatic spread usually occurs only after invasion into adjacent normal tissue.
• B. They are painful: False. Scar tissue lacks nerve endings, therefore pain is typically a late feature.
• C. They are aggressive and fast-growing tumors: False. Marjolin ulcers are generally slow-growing because of the avascular nature of scar tissue, although they possess metastatic potential.

High-yield teaching points

• Marjolin ulcer = malignant transformation in a chronic scar or ulcer.
• Most common histology: Squamous cell carcinoma. ⭐
• Classically develops in long-standing burn scars.
• Can also occur in venous ulcers, pressure sores, osteomyelitic sinuses, and chronic wounds.
• Pain and lymphatic spread are usually late features.
• Scar tissue is relatively devoid of lymphatics and nerve endings.
• Although slow growing, these lesions can metastasize once they invade surrounding healthy tissue.
• Bailey & Love 28th Edition, Page 625.