Malignant Degeneration of Burn Scars (Marjolin's Ulcer): A Retrospective Case Series of Nine Patients

Introduction Malignant degeneration of burn scars, commonly referred to as Marjolin's ulcer, is a rare but aggressive complication of chronic scars. Squamous cell carcinoma is the most frequent histological type, although other variants may occur. The aim of this study was to describe the epidemiological, clinical, histopathological, and therapeutic characteristics of patients treated in our department. Methods We conducted a retrospective descriptive study including patients with histologically confirmed malignant tumors arising on burn scars, treated between January 2019 and March 2026 at Mohammed VI University Hospital in Oujda, Morocco. Demographic, clinical, histological, therapeutic, and outcome data were analyzed. Results Nine patients were included, with a mean age of 58.6 years (range 47-71 years). There was a clear male predominance (88.9%). The lower extremities were the most commonly affected site (55.6%). Histologically, eight patients presented tumors within the squamous cell carcinoma spectrum, including three verrucous variants, while one patient developed a high-grade sarcomatous transformation on the same burn scar. Treatment was primarily surgical, including wide excision, reconstruction with skin grafts or flaps, and amputation in advanced cases. The amputation rate was 22.2%, and adjuvant radiotherapy was administered in 44.4% of cases. Conclusion Marjolin's ulcer remains a rare but aggressive entity requiring early diagnosis and prompt surgical management. Any chronic or unstable burn scar showing recent changes should be biopsied. The possibility of rare histological transformations highlights the need for careful pathological evaluation.