Characteristics of Marjolin’s ulcer canceration. To better understand the characteristics of Marjolin’s ulcer samples, Marjolin’s Ulcer was sorted by canceration level including squamous cell carcinoma, basal cell carcinomas, sarcoma and malignant melanoma (Fig. 1). Furthermore, the frequency of pathological types and invasion depth of Marjolin’s ulcer canceration was analyzed. As shown in Table 1, The SCC was the most common type in the patients of Marjolin’s ulcer (86.7%). Among of SCC, high differentiation was primary compared to moderate and poor differentiation. Other pathological types of ulcer canceration were basal cell carcinomas (7.5%), malignant melanoma (4.7%) and sarcoma (0.9%)(Table 1). Moreover, the depth of tumor invasion mainly reached dermis (89.6%), followed by bone and muscle (10.4%)(Table 1).
Table 1
Frequency of pathological types and invasion depth of Marjolin’s ulcer canceration
Pathological types and invasion depth | Frequency, n(%) |
Pathological types | Squamous cell carcinoma | High differentiation | 51(48.1) |
Moderate differentiation | 33(31.1) |
Poor differentiation | 8(7.5) |
Basal cell carcinomas | 8(7.5) |
Malignant melanoma | 5(4.7) |
Sarcoma and others | 1(0.9) |
Depth of tumor invasion | Dermis | 95(89.6) |
Bone and muscle | 11(10.4) |
Expression of HER2 and p53 in Marjolin’s ulcer. To explore whether Marjolin’s ulcer expressed HER2 and p53, Marjolin’s ulcer samples were detected by immunohistochemical assay with anti-HER2 and anti-p53 antibody respectively. As result shown, all patients in the Marjolin’s ulcer group had negative expression of HER2 (Fig. 2). Interestingly, we found p53 was detected in Marjolin’s ulcer samples (Fig. 3). The positive expression rate of p53 was 56.6% in Marjolin's ulcer totally (Table 2). |
Clinicopathological characteristics of Majorlin's ulcer samples. To better understand the regularity of p53 occurrence in the context of Majorlin's ulcer, we explore the relationship of p53 expression with clinicopathological characteristics of Majorlin's ulcer samples. As shown in Table 2, male patients had lower positive expression rate of p53 than female patients (41.3% vs. 79.1%, χ2 = 14.866, P < 0.05). Furthermore, the positive expression rate of p53 was 63.3% for patients with course over 20 years, none of patients with course between 10 and 20 years, and 52.6% for patients with course less than 5 years (χ2 = 11.995, P < 0.05). The positive expression rates of p53 with ulcer area less than 2 cm, in 2.1-5 cm, and over 5 cm were respectively 75.0%, 44.6%, and 76.2% (χ2 = 9.838, P < 0.05). The positive expression rates of p53 were 53.3%, 62.5%, 100%, and 0 for patients with SCC, basal cell carcinoma, malignant melanoma, and sarcoma, respectively (χ2 = 20.172,P < 0.05), which indicated that the degree of malignancy of Marjolin’s ulcer was proportional to the positive expression rate of p53. The positive expression rates of p53 were 35.3%, 75.6%, and 75.0% for well-differentiated SCC, moderately differentiated SCC, and poorly differentiated SCC (χ2 = 14.841, P < 0.05). Hence, the positive rate of p53 was associated with sex, course of disease, ulcer size, pathological type of ulcer canceration, and degree of tumor differentiationa, and there was no significant difference in the positive expression rates of p53 between patients with different age, etiologies, lesion location, depth of tumor invasion, and prognosis (Table 2).
Table 2
Expression of p53 in the patients with Marjolin’s ulcer.
Clinical characteristics | Group | Number of samples (n) | ++ | ++ | - | Positive expression rate | χ2 value and P value |
Sex | male | 63 | 10 | 16 | 37 | 41.3% | χ2 = 14.866, P < 0.05 |
female | 43 | 21 | 13 | 9 | 79.1% |
Age (years) | 0–10 | 0 | 0 | 0 | 0 | 0 | χ2 = 3.346, P > 0.05 |
11–20 | 2 | 0 | 0 | 2 | 0 |
21–30 | 12 | 4 | 2 | 6 | 50% |
31–40 |
41–50 | 59 | 18 | 18 | 23 | 61.0% |
51–60 |
61–70 | 33 | 9 | 9 | 15 | 54.5% |
71–80 |
81–90 |
> 90 |
Course of disease (years) | < 5 | 19 | 10 | 0 | 9 | 52.6% | χ2 = 11.995, P < 0.05 |
5–10 | 0 | 0 | 0 | 0 | 0 |
10–20 | 0 | 0 | 0 | 8 | 0 |
> 20 | 79 | 21 | 29 | 29 | 63.3% |
Etiologies | Burn | 92 | 25 | 26 | 41 | 55.4% | χ2 = 2.481, P > 0.05 |
Bedsore | 6 | 2 | 1 | 3 | 50% |
Diabetes | 5 | 2 | 1 | 2 | 60% |
Trauma | 2 | 1 | 1 | 0 | 100% |
Other | 1 | 1 | 0 | 0 | 100% |
Ulcer size (cm) | 0–2 | 20 | 10 | 5 | 5 | 75% | χ2 = 9.838, P < 0.05 |
2.1-5 | 65 | 10 | 19 | 36 | 44.6% |
> 5 | 21 | 11 | 5 | 5 | 76.2% |
Lesion location | Head and neck region | 34 | 20 | 2 | 12 | 64.7% | χ2 = 5.568, P > 0.05 |
Upper limbs | 19 | 8 | 5 | 6 | 68.4% |
Trunk | 5 | 0 | 1 | 4 | 20% |
Lower limbs | 48 | 3 | 21 | 24 | 50% |
Prognosis | Recurrence | 19 | 7 | 4 | 8 | 57.9% | χ2 = 4.456, P > 0.05 |
Death | 5 | 4 | 0 | 1 | 80% |
Lose | 9 | 4 | 2 | 3 | 66.7% |
Cure | 56 | 7 | 20 | 29 | 48.2% |
Not delay | 17 | 9 | 3 | 5 | 70.6% |
Pathological types of ulcer canceration | Degree of tumor differenciation | Well- differentiation | 51 | 3 | 15 | 33 | 35.3% | χ2 = 14.841,P < 0.05 | χ2 = 20.172,P < 0.05 |
Moderate differentiation | 33 | 19 | 6 | 8 | 75.6% |
Poor differentiation | 8 | 5 | 1 | 2 | 75% |
| Basal cell carcinomas | 8 | 2 | 3 | 3 | 62.5% | |
| Malignant melanoma | 5 | 3 | 2 | 0 | 100% |
| Sarcoma and others | 1 | 0 | 0 | 1 | 0 |
Depth of tumor invasion | Dermis | 95 | 24 | 28 | 43 | 54.7% | χ2 = 1.299, P > 0.05 |
Bone and muscle | 11 | 7 | 1 | 3 | 72.7% |