Surgical Management of a Marjolin's Ulcer of the Scalp Following Recurrent Chemical Burns.

Abstract

Marjolin's ulcer is an aggressive cutaneous malignancy that arises from chronic, non-healing wounds, with squamous cell carcinoma (SCC) being the most common histologic type. Marjolin's ulcers typically develop from chronic inflammatory states, including scars from chemical burns. We present the case of a 53-year-old woman with a 15 × 17 cm Marjolin's scalp ulcer, secondary to recurrent chemical burns from continued permanent wave (perm) treatments. Following work-up, the lesion was diagnosed as cT4N2M0 SCC of the scalp, classifying it as clinical stage IV disease. Due to extensive invasion into the dura, a multidisciplinary surgical intervention was required: surgical oncology for tumor resection with bilateral neck dissections, neurosurgery for craniectomy, craniofacial surgery for cranioplasty, and plastic surgery for finalized closure with a latissimus free flap. This case highlights the importance of a multidisciplinary approach in managing large, invasive Marjolin's ulcers, as well as the rare occurrence of malignant transformation secondary to recurrent perm burns.