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DOI:10.2214/AJR.07.2341
AJR 2007; 189:W171
© American Roentgen Ray Society

MRI of Marjolin's Ulcer

Orla Buckley, Emily Ward, Peter L. Munk and William C. Torreggiani

The Adelaide and Meath Hospital Dublin, Ireland
Vancouver General Hospital Vancouver, BC, Canada
The Adelaide and Meath Hospital Dublin, Ireland



 
WEB—This is a Web exclusive article.

We read with interest the case report by Chiang et al. [1] in which the authors describe the MRI features of a Marjolin's ulcer in a 47-year-old man, which developed in the area of a burn scar. In their discussion, the authors eloquently describe the utility of MRI in defining the extent of bone destruction, the margins of the lesion, and the associated soft-tissue mass. In the past, radiographic films were used to assess bone destruction, but the authors correctly point out the advantage MRI confers over radiographs. MRI in their case provided clear definition of the margins of the ulcer, allowing accurate lesion identification and aiding potential preoperative planning. In addition, the authors pointed out the usefulness of gadolinium enhancement to further characterize the nature and extent of the ulcer in their case.


Figure 1
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  		Fig. 1A —42-year-old man with Marjolin's ulcer. Anteroposterior radiograph of tibia and fibula show evidence of old fracture that has not united and chronic osteomyelitis with associated varus deformity.

 


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  		Fig. 1B —42-year-old man with Marjolin's ulcer. Coronal T1-weighted MRI of same region shows enhancing mass involving overlying skin and extending into underlying bone.

 
We would like to further their case by describing a 42-year-old man we encountered who developed a Marjolin's ulcer secondary to chronic osteomyelitis. Initial radiographs in our case showed evidence of an old fracture and features of chronic osteomyelitis (Fig. 1A). Contrast-enhanced MRI showed an enhancing mass involving both the cutaneous and osseous structures, suggesting the possibility of a complicating Marjolin's ulcer (Fig. 1B). This was confirmed on biopsy. As in the case described by Chiang et al. [1], MRI in our case was able not only to suggest the presence of a Marjolin's ulcer but also to depict its extent and relationship to the underlying region of chronic osteomyelitis. In addition, we found contrast enhancement to be a useful adjunct in depicting the extent of the lesion. Therefore, in agreement with Chiang et al., we conclude that that MRI should be used as the imaging technique of choice in assessing Marjolin's ulcer, regardless of the underlying associated cause. In addition we also think that contrast enhancement is useful in such cases.


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  1. Chiang KH, Chou AS, Hsu YH, et al. Marjolin's ulcer: MR appearance. AJR 2006; 186:819 -920[Free Full Text]

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K.-H. Chiang, A. S.-B. Chou, and P.-Y. Chang
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Am. J. Roentgenol., September 1, 2008; 191(3): W151 - W151.
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