Mucosal Cancers Arising in Potentially Malignant Lesions of the Oral Mucosa Are Marjolin Ulcers: New Insights Into Old Concepts
Keywords:
Potentially malignant lesions, premalignant lesions, oral lichen planus, Marjolin’s ulcer, squamous cell carcinomaAbstract
Introduction: Several disparate mucocutaneous diseases present oral mucosal lesions that have been classically labeled as “pre-cancerous,” “pre-malignant,” or “potentially malignant” These include oral lichen planus, dyskeratosis congenita, tertiary syphilitic glossitis chronic graft-versus-host-disease, and oral discoid lupus erythematosus. There is much confusion in literature regarding the real malignant potential of these oral lesions in relation to the incidence of squamous cell carcinoma.
Objective: We tried to unify the occurrence of squamous cell carcinoma in some oral mucosal diseases into the classic concept of Marjolin ulcer.
Method: We analyzed the most relevant published evidence of the occurrence of squamous cell carcinoma (SCC) arising in oral lichen planus, dyskeratosis congenita, tertiary syphilitic glossitis chronic graft-versus-host-disease, and oral discoid lupus erythematosus, and tried to establish a logical link between them.
Results: Reported cases of SCC occurring in oral lesions of these diseases seem to appear in old-standing, scarring lesions.
Conclusion: Oral lichen planus, dyskeratosis congenita, tertiary syphilitic glossitis, chronic graft-versus-host-disease, and oral discoid lupus erythematosus are not “pre-malignant diseases,” their long-lasting mucosal scars are prone to the development of SCC. In this sense, this tumor can be considered a mucosal type of Marjolin ulcer.
References
- Birur PN, Patrick S, Warnakulasuriya S, Gurushanth K, Raghavan SA, Rath GK, Chaturvedi P, Chandru V, Mathew B, Prabhash K, Gurudath S, Mukhia N, Sunny SP, Mehrotra R, Vivek V, Patil S, Kumar GS, Fasalkar S, Pratima R, Kuriakose MA. Consensus guidelines on management of oral potentially malignant disorders. Indian J Cancer 2022; 59:442-443. doi: 10.4103/ijc.IJC_128_21. PMID: 36412324.
- Ion DI, Setterfield JF. Oral Lichen Planus. Prim Dent J. 2016; 5:40-4. doi: 10.1177/205016841600500104. PMID: 29029652.
- Al Sabbagh MM. Dyskeratosis congenita: A literature review. J Dtsch Dermatol Ges 2020; 18: 943–947. doi: 10.1111/ddg.14268. PMID: 32930426.
- Rahima S, Riyaz N, Latheef EN, Shyni PM. Squamous cell carcinoma on a syphilitic gumma: A unique presentation. Indian J Sex Transm Dis, AIDS 2015; 36:89-91. doi: 10.4103/0253-7184.156745. PMID: 26392665.
- Monteiro MF, Lemos JG, Pontes FS, Silva AC, Silva MH, Silva NF, Souza LL, Uchôa DC, Pontes HA. Oral squamous cell carcinoma arising from areas of Graft-versus-host disease: A systematic review. Med Oral Patol Oral Cir Bucal 2024; 29:e135-144. doi: 10.4317/medoral.26133. PMID: 37992141.
- Mufti A, Sachdeva M, Maliyar K, Sibbald RG. Squamous cell carcinoma arising within discoid lupus erythematous lesions: a systematic review. JAAD Int 2021; 2:1-4. doi: 10.1016/j.jdin.2020.10.001. PMID: 34409345.
- Bazaliński D, Przybek-Mita J, Barańska B, Więch P. Marjolin's ulcer in chronic wounds - review of available literature. Contemp Oncol (Pozn) 2017; 21:197-202. doi: 10.5114/wo.2017.70109. PMID: 29180925.
- Azevedo CM, Marques SG, Santos DW, Silva RR, Silva NF, Santos DA, Resende-Stoianoff MA. Squamous cell carcinoma derived from chronic chromoblastomycosis in Brazil. Clin Infect Dis 2015; 60:1500-1504. doi: 10.1093/cid/civ104.. PMID: 25681378.
- Huang C, Lai Z, He M, Zhai B, Zhou L, Long X. Successful surgical treatment for squamous cell carcinoma arising from hidradenitis suppurativa: A case report and literature review. Medicine (Baltimore) 2017, 96:e5857. doi: 10.1097/MD.0000000000005857. PMID: 28099342.
- Goerttler EA, Jung EG. Porokeratosis [correction of Parakeratosis] Mibelli and skin carcinoma: a critical review. Humangenetik 1975; 26:291-296. PMID: 1097326.
- Hagiwara K, Uezato H, Miyazato H, Nonaka S. Squamous cell carcinoma arising from lupus vulgaris on an old burn scar: diagnosis by polymerase chain reaction. J Dermatol 1996; 23:883-889. doi: 10.1111/j.1346-8138.1996.tb02719.x. PMID: 9037920.
- Bonamonte D, Filoni A, De Marco A, Lospalluti L, Nacchiero E, Ronghi V, Colagrande A, Giudice G, Cazzato G. Squamous Cell Carcinoma in Patients with Inherited Epidermolysis Bullosa: Review of Current Literature. Cells 2022; 11:1365. doi: 10.3390/cells11081365. PMID: 35456044.
- Ju T, Ingrasci G, Diaz-Perez JA, Obayomi A, Yosipovitch G. Development of squamous cell carcinoma in the setting of chronic discoid lupus erythematosus may be associated with plasmacytoid dendritic cell inflammation. J Cutan Pathol 2022; 50: 19–23. 10.1111/cup.14304. PMID: 35922371.
- Nico MM, Fernandes JD, Lourenço SV. Oral lichen planus. An Bras Dermatol 2011; 86:633-641. doi: 10.1590/s0365-05962011000400002. PMID: 21987126.
- Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol 2002; 46:207-214. 10.1067/mjd.2002.120452. PMID: 11807431.
- Ismail SB, Kumar SK, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci 2007; 49:89-106. doi: 10.2334/josnusd.49.89. PMID: 17634721.
- Laniosz V, Torgerson RR, Ramos-Rodriguez AJ, Ma JE, Mara KC, Weaver AL, Bruce AJ. Incidence of squamous cell carcinoma in oral lichen planus: a 25-year population-based study. Int J Dermatol 2019 Mar;58:296-301. doi: 10.1111/ijd.14215. PMID: 30216435.
- Erthal A, Lourenço SV, Nico MMS. Oral lichen planus: case series and experience in a tertiary dermatology service in Brazil. An Bras Dermatol 2023; 98:493-497. doi: 10.1016/j.abd.2022.06.005. PMID: 36964105.
- Patel GK, Turner RJ, Marks R. Cutaneous lichen planus and squamous cell carcinoma. J Eur Acad Dermatol Venereol 2003; 17: 98–100. 10.1046/j.1468-3083.2003.00519_2.x. PMID: 12602985.
- Takatu CM, Gabbi TVB, Nico MMS. Squamous Cell Carcinoma Arising in Ungual Lichen Planus: Report and Review. Skin Appendage Disord 2021; 7:54-57. doi: 10.1159/000511094. PMID: 33614721.
- Arvanitidou IE, Nikitakis NG, Georgaki M, Papadogeorgakis N, Tzioufas A, Sklavounou A. Multiple primary squamous cell carcinomas of the lower lip and tongue arising in discoid lupus erythematosus: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;125:e22-e30. doi: 10.1016/j.oooo.2017.08.012. PMID: 28967499.
- Yendo TM, Gabbi TVB, Nico MMS. Squamous Cell Carcinoma Arising in Discoid Lupus Erythematosus of the Nail Unit. Skin Appendage Disord 2023; 9:221-223. doi: 10.1159/000529360. PMID: 37325277.
- Nico MMS, Yendo TM, Lourenço SV. Understanding oral mucosal lesions in dyskeratosis congenita: from interface inflammation to squamous cell carcinoma, an observational report. Int J Dermatol 2022; 61:e366-e368. doi: 10.1111/ijd.16215. PMID: 35388911.
- Handley TPB, Ogden GR. Dyskeratosis congenita: Oral hyperkeratosis in association with lichenoid reaction. J Oral Pathol Med 2006; 35: 508–512. doi: 10.1111/j.1600-0714.2006.00434.x. PMID: 16918603.
- Nico MM, Hammerschmidt M, Lourenço SV. Oral mucosal manifestations in some genodermatoses: correlation with cutaneous lesions. Eur J Dermatol 2013; 23:581-591. doi: 10.1684/ejd.2013.2073. PMID: 24001555.
- Dickenson AJ, Currie WJ, Avery BS. Screening for syphilis in patients with carcinoma of the tongue. Br J Oral Maxillofac Surg 1995; 33:319-320. . doi: 10.1016/0266-4356(95)90046-2. PMID: 8555151.
- Joshi R. Interface dermatitis. Indian J Dermatol Venereol Leprol 2013; 79:349-359. doi: 10.4103/0378-6323.110780. PMID: 23619439.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Nycolle Louise Guedes, Silvia Vanessa Lourenço, Marcello Nico
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.