Marjolin's Ulcer over Lower Extremities-A Review of 17 Cases and a Revisit of Their Treatment Modalities

Marjolin's ulcer 是源自皮膚潰瘍或疤痕的惡性腫瘤，標準的治療方法包括廣泛性切除並覆蓋表皮皮片或是膝蓋上、膝蓋下截肢，但是對於是否需要作預防性的腹股溝淋巴結擴清來避免遠處轉移則仍存有爭議。在本文中我們回顧了過去八年來在台大醫院跟恩主公醫院就醫的患者中，位於下肢的Marjolin's ulcer而且病理報告爲鱗狀上皮細胞癌總共有十七例，所有的病人均接受上述的標準手術治療。但是都沒有接受淋巴結擴清手術因爲病理報告均顯示爲低度的(low grade)鱗狀上皮細胞癌。在一到八年的門診追蹤裡面，有兩例患者的病理報告顯示腫瘤的邊緣並沒有切除乾淨，但病人拒絕再作進一步的切除手術，這兩例病人在術後發現有遠處轉移(120%)。相較於國外文獻的報告，遠處轉移的機率約爲(30%)。根據我們的研究，對於位於下肢的低度鱗狀上皮細胞癌其遠處轉移的機率相對較低，預防性的淋巴結擴清手術並不一定須要。同時在本文中，我們也對Marjolin's ulcer的歷史、臨床表現、治療及預後方面也作一個回顧。

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並列摘要

Marjolin's ulcer is a malignancy arising from skin ulcers or scars. Wide excision with skin graft or above knee/below knee (AK/BK) amputation is a standard procedure for treating the disease when it occurs on the lower extremities. However, using prophylactic inguinal lymph node dissection to prevent distant metastasis remains controversial. Retrospectively, we reviewed 17 patients of Marjolin's ulcer of the lower extremities who received the above-mentioned surgical procedures to treat the disease, but did not receive prophylactic inguinal lymph node dissection. In the one-to-eight-year follow-up period, only two patients (11.7%) had distant metastasis and cancerous cells within their original section margin. Compared with metastatic rate of around 30% in other reports, our study revealed a relatively lower metastatic rate of our patients whose Marjolin's ulcer was low grade SCC on their lower extremities. Therefore, prophylactic inguinal lymph node dissection is not recommended. In this article, we review the matters of history, clinical presentation, treatment, and prognosis.

並列關鍵字

Marjolin's ulcer ； squamous cell carcinoma

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Marjolin's Ulcer over Lower Extremities-A Review of 17 Cases and a Revisit of Their Treatment Modalities

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