What is a Marjolin’s Ulcer?
An aggressive transformation of a chronic wound into a degenerative malignant skin lesion.
Describe where 90% of Marjolin’s Ulcers will develop from?
Scars from burns
Where do Marjolin’s Ulcers often occur?
They can occur in all types of chronic wounds especially burns, osteomyelitis, leg ulcers, pressure ulcers and fistulae.
Histological examination of a Marjolin’s Ulcer will show in around 95% of cases to be related to what type of cancer?
SCC are 95% of Marjolin Ulcer cases.
Describe the characteristics of Marjolin’s Ulcers wound edges?
Well defined margins and lots of granulation tissue
How is a diagnosis of Marjolin’s Ulcer reached?
- A punch biopsy of the mole was taken and sent to histology.
- Broad shave biopsy
- Incisional biopsy
- Deep shave biopsy
What is the first Line Treatment for Marjolin’s ulcer?
Supporting the pt through the provision of strengthening their coping skills and keeping optimal wound management.
When Osteomyelitis is present or a Marjolin’s Ulcer reoccurs, what might be the recommended treatment?
Amputation of extremity
What other considerations are there when caring for a patient with a Marjolin’s Ulcer or any other form of Chronic Ulcer?
- Nurse needs to give pt’s information sensitively, establish a therapeutic relationship to allow for questioning and open a portal for communication.
- Undertake an assessment for management of – odour, pain relief, product selection, diet, lifestyle or behaviour issues, psychological state and risk, comorbidities, environmental factors, palliative care issues
- Consider consultation with Wound care specialist, dietican, podiatrist etc
- Provide information and resources for pt to gain deeper understanding
What it important to observe and document when you are doing a wound dressing?
- Need to continuously be reassessing the wound, the pt and the wound environment.
- Need to be documenting the amount of exudate, if odour is apartment, pain assessment and the type of wound dressing used, the size of the wound (depth, width, length and shape) and if it is growing or healing.
- Other factors to document – wound swab results, effectiveness of pain relief if given or in need of.
What would you do if you were a community nurse and the patients wound was not improving? What might you suspect?
- Infection – assessment of pt required, document findings and inform DR/wound care specialist,
- review any medication they are currently taking as this may not be the right antibiotics
- Depression
- Nutritional problems
What specific discharge advice could you provide to your patient following a wide excision and SSG?
- The management of the wound, what to be looking for and when to seek medical attention if infection may be present, dressing of the wound, pain management and medication management, nutritional support.
- Education about care of wound and lifestyle modifications
Is it true that Marjolin’s ulcers are a common cutaneous malignancy?
False
What are some causes of skin cancer? List 4
- complexion
- age
- mole count
- relatives
- genetics
- damaging effects of UV radiation
- breakdown of Immune Protection
List at least 3 characteristics of a malignant mole.
- asymmetrical
- borders are uneven
- 2 or more colours
- larger than 1/4 inch
- changing in size, shape, colour
describe a basal cell carcinoma.
It is a slow-growing neoplasm that is locally invasive but rarely metastasizes. It is derived from basal cells, the deepest layer of epithelial cells of the epidermis or hair follicles.
Describe a squamous cell carcinoma.
It is a carcinoma that arises from squamous epithelium and is the most common form of skin cancer.
Describe what a melanoma is.
A melanoma is a malignant cancer that starts from the pigment cells (melanocytes) of the skin.
list some characteristics of a Basal cell carcinoma.
- waxy, nodule with rolled translucent pearly borders
- nodular, pigmented, superficial lesion
- rarely matastasises
- occurs from single layer of basal cells between the dermis and epidermis
List some characteristics of a Squamous cell carcinoma.
- rough, thickened scaly lesion
- higher incidence of metastasis and is invasive
- is a tumour on the keratinising cells of the epidermis
What are the benefits of using negative pressure dressings?
- optimises blood flow in the wound bed
- decreases local tissue swelling
- removes excessive fluid that can slow cell growth and proliferation in the wound bed
- decreases number of bacteria
What are some contra-indications for negative-pressure wound therapy?
- fistulas
- necrotic tissue
- osteomyelitis
- wounds due to skin cancer
