Marjolin's ulcer: A rare case of malignancy of a fistulous tract in chronic hidradenitis suppurativa

A 61-year-old male, diagnosed with hidradenitis suppurativa more than 25 years prior, presented with a gluteal fistula treated conservatively with debridement and wound care, with an unfavourable response. Given the poor evolution despite the treatment, a biopsy was performed due to suspicion of malignancy, confirming the diagnosis of squamous cell carcinoma arising from a chronic fistulous tract (Marjolin's ulcer). CT showed no metastatic involvement, and MRI revealed a locally advanced neoplasm due to involvement of the sphincter apparatus (infiltration of the external anal sphincter and puborectalis muscle, with questionable contact with the internal anal sphincter) (Fig. 1).

Fig. 1

After being presented to the multidisciplinary committee, treatment with chemoradiotherapy and immunotherapy was initiated, without achieving a complete response. In the subsequent re-evaluation, surgical treatment was decided upon, consisting of an abdominoperineal resection (Fig. 2) with reconstruction using a V–Y flap. After the procedure, the patient had a favourable outcome and was discharged home without complications.

Fig. 2

Marjolin's ulcer is an infrequent but potentially serious complication due to its metastatic potential. It can develop in up to 4.6% of patients with chronic hidradenitis suppurativa. Perianal location is exceptional, representing approximately 2% of cases. The most frequent histological subtype is squamous cell carcinoma, with a higher prevalence in men than in women (3:1), especially after the fifth decade of life.

Close monitoring and early intervention in patients with hidradenitis suppurativa, especially those with long-standing lesions, are essential for proper management. Surgical treatment by abdominoperineal resection may be considered in cases of locally advanced disease as a salvage strategy after treatment with chemoradiotherapy and immunotherapy when a complete response is not achieved, constituting an infrequent but relevant salvage therapeutic strategy in selected situations.

Diagnosis: Perianal Marjolin’s ulcer.

Declaration of originality

The authors declare that this is an original publication. This study has not been published nor is it under review by another journal.

Funding

No funding was obtained for this study.