Marjolin's ulcer: incidental diagnosis of squamous cell carcinoma on hemipelvectomy for recalcitrant pelvic osteomyelitis

Abstract

Hemipelvectomy is a radical surgical procedure reserved for particularly devastating pathology including recalcitrant pelvic osteomyelitis. We describe the incidental diagnosis of a metastatic squamous cell carcinoma by pathology after hemipelvectomy for pelvic osteomyelitis. This tumor was located deep within the chronic wound and deemed to be a Marjolin's ulcer (malignant transformation within a chronic wound). There are multiple reports and case series describing hemipelvectomy for tumor or infection, as well as one case report of a tumor arising years after successful surgical treatment of a chronic decubitus ulcer, but we were unable to find any describing the diagnosis of a Marjolin's ulcer at pathology following hemipelvectomy for osteomyelitis. This case demonstrates the diagnostic dilemma of malignant transformation within a chronic wound and is an opportunity to highlight the interventions necessary to prevent such progression.

Figure 1

9/8/09 preoperative pelvis x-ray.

Figure 2

10/31/09 - postoperative CT.