Scar Carcinoma (Marjolin Ulcer) and Bullous Disease

The bullous dermatoses are a heterogeneous group of blistering disorders that can either be inherited or acquired and which result from loss of cellular adhesion within the dermoepidermal complex. These disorders can be classified by the level at which the separation occurs, with the most severely affected patients having a dysfunction of the adhesion molecules at the lower levels of the dermoepidermal junction. The patients in this latter category frequently have recurrent lesions that resolve, with significant scarring contributing to the increased morbidity and mortality. In this article, we discuss 2 patients who had different bullous dermatoses yet presented with similar slowly enlarging suppurative masses that arose within scars on their extremities. We discuss the proposed pathogenesis of scar carcinoma (Marjolin ulcer) and explain the role that chronic inflammation plays in carcinogenesis. We conclude by discussing the different types of squamous cell carcinoma and the clinicopathologic features that have been shown to be of prognostic value.