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Case presentation

–Marjolin,s ulcer
• complaining of non-healing
ulcer in the lower Rt. leg of
2 years duration.
• Saeedia muhamad shukry
25 years old typist lady from
Sulaimani, presents to me
on 20th nov. 2003,
• The condition started 2
years ago after revision of
the scare of old burn (15
years old), a small area
remain uncovered,
• became larger gradually
over the last 2 years.
• To became as large as a
small apple.
• There was a serous
discharge for the lesion,
which was neither
painful, nor ltchy
• . She thought that it’s
due to disruption of the
sutune line of the last
•On local
examination ;
There was large round ulcer about
10 cm in diameter, 3 mm depth in
thecentre&5 mm hieght at the
which was regular, surround by a
scared skin with everted margin,
•, dirty & sloughing floor
• Non tender, of same
temp. as
surrounding the
base in indurated
–No regional LNs
• arranged for wedge
biopsy, which
revealed Sq. C. C.
Few facts about Marjolins ulcer
• Marjolin,s ulcer is an eponym reserved for
a squamous carcinoma which arises in a
long-standing benign ulcer or scar.
• The most common ulcer to become
malignant is a long standing venous ulcer
• The scar that is most often associated with
malignant change is the scar of an old
• These carcinomata have
characteristics similar to those of the
ordinary squamous carcinoma except
that they may not be so florid. Their
edge is not always raised and
everted, and other features may be
masked by the pre-existing chronic
ulceration or scarring. Unusual
nodules or changes in a chronic ulcer
or a scar should be viewed with
Slow growing
No LN metastasin

• This type of carcinoma is not so

invasive, slower growing and
slightly less malignant than the
spontaneous squamous
carcinoma, but must be treated as
• A carcinomatous ulcer has everted edges
which to the palpating fingers feel hard.
• A Carcinomatous Ulcer (epithelioma,
squamous-cell carcinoma of skin) can
hardly be mistaken, especially after the
evasion and the induration of the edge of
the ulcer have been observed mollucsum
sebaceum may be confused with
‫سوثاس بؤ طويَ طرتنتان‬
Bo hatwan
• Cholesterol-lowering strategies, including a low saturated-fat diet,
• weight loss,
• physical activity and
• medication, all focus on reaching a particular LDL goal..
• You can modify some risk factors, such as
• smoking and
• high blood pressure,
• Having even one risk factor increases your chance of developing
heart disease at some time.
• The good news is that measures you take to reduce your LDL
cholesterol will also help reduce your blood pressure and weight
and control your diabetes, if you have it.