{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T11:04:24Z","timestamp":1793963064026,"version":"4.8.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Second Affiliated Hospital of Dalian Medical University"},{"name":"\u201c1\u2009+\u2009X\u201d Program Clinical Technology Level Improvement Project Task Book","award":["2022LCJSYS17"],"award-info":[{"award-number":["2022LCJSYS17"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to analyze the clinical features and diagnostic challenges of cutaneous squamous cell carcinoma arising from chronic limb wounds\u2014a condition known as a Marjolin ulcer\u2014to summarize practical warning signals for early recognition and to explore the underlying mechanism of malignant transformation associated with chronic inflammation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present a detailed report of four elderly male patients. All of them had long-standing, non-healing chronic wounds on the limbs, with initial triggers including an ingrown nail, a foreign body injury, a post-surgical scar from a calcaneal fracture, and an abrasion. The wound duration ranged from 8\u202fmonths to 30\u202fyears. Clinical presentations, imaging findings, surgical procedures, pathological results, and short-term postoperative outcomes were systematically reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All patients were initially misdiagnosed with benign chronic wounds, leading to diagnostic delays from months to decades. Final surgical pathology confirmed cutaneous squamous cell carcinoma in every case, with bone invasion present in two cases. Owing to these delays, treatment escalated from potentially curative local excision to amputation in three of the four cases. No local recurrence was detected during the short-term follow-up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on these cases, we propose a practical set of clinical warning signals centered on wound chronicity, abnormal morphology, and patient demographics. Long-standing, non-healing wounds on the limbs of elderly male patients should prompt suspicion of malignant transformation. Early biopsy is essential to avoid devastating outcomes such as amputation. The chronic inflammatory microenvironment appears to serve as a continuous driving force behind this cancer development pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1838998","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:41:42Z","timestamp":1781152902000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Marjolin ulcer characterized by squamous cell carcinoma arising from chronic wounds: clinical features, diagnostic and therapeutic challenges, and insights\u2014a report of four cases"],"prefix":"10.3389","volume":"13","author":[{"given":"Lianbo","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Orthopedic and Soft Tissue Reconstruction Surgery, The Second Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinming","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Soft Tissue Reconstruction Surgery, The Second Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanchen","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Soft Tissue Reconstruction Surgery, The Second Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyi","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Soft Tissue Reconstruction Surgery, The Second Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Soft Tissue Reconstruction Surgery, The Second Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyu","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Soft Tissue Reconstruction Surgery, The Second Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Soft Tissue Reconstruction Surgery, The Second Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haidong","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Soft Tissue Reconstruction Surgery, The Second Hospital of Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1200\/GO.20.00094","article-title":"Systematic review of modern case series of squamous cell Cancer arising in a chronic ulcer (Marjolin's ulcer) of the skin","volume":"6","author":"Abdi","year":"2020","journal-title":"JCO Glob Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2379","DOI":"10.1158\/1078-0432.CCR-18-1122","article-title":"Keratinocyte carcinomas: current concepts and future research priorities","volume":"25","author":"Nagarajan","year":"2019","journal-title":"Clin Cancer Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2904","DOI":"10.3390\/cancers16162904","article-title":"The mutational and microenvironmental landscape of cutaneous squamous cell carcinoma: a review","volume":"16","author":"Hosseini","year":"2024","journal-title":"Cancers (Basel)"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.3390\/cancers17101702","article-title":"Current and emerging insights into the causes, Immunopathogenesis, and treatment of cutaneous squamous cell carcinoma","volume":"17","author":"Anderson","year":"2025","journal-title":"Cancers (Basel)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1056\/NEJM200103293441306","article-title":"Cutaneous squamous-cell carcinoma","volume":"344","author":"Alam","year":"2001","journal-title":"N Engl J Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"113251","DOI":"10.1016\/j.ejca.2023.113251","article-title":"European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. 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