Modern surgery, general and operative . e 449). Marjolins vdcer (Figs. 82-86) is an epithelioma arising from a chroniculcer or an old cicatrix. The mahgnant change begins at some point of theedge of the ulcer, and its first evidence is induration. The induration spreadsslowly and comes to involve a considerable part of or even the entire ulcer is the seat of scalding, darting pain; the discharge is profuse,ichorous, and foul, and the floor of the ulcer is uneven, warty, or cauliflower-Hke. The anatomically related lymph-glands eventually become involvement is seld
Modern surgery, general and operative . e 449). Marjolins vdcer (Figs. 82-86) is an epithelioma arising from a chroniculcer or an old cicatrix. The mahgnant change begins at some point of theedge of the ulcer, and its first evidence is induration. The induration spreadsslowly and comes to involve a considerable part of or even the entire ulcer is the seat of scalding, darting pain; the discharge is profuse,ichorous, and foul, and the floor of the ulcer is uneven, warty, or cauliflower-Hke. The anatomically related lymph-glands eventually become involvement is seldom early because induration has blocked lymph-channels. In order to confirm the diagnosis a bit of tissue should be removed,and the removed piece must include a portion of the edge of the ulcer andof some apparently sound tissue beyond it. If a microscopic examinationshows epithelial infiltration of the apparently sound tissue, a diagnosis ofmalignant disease must be made. In an early stage of such an ulcer the 1 Principles of Fig. 84.—Marjolins ulcer (epithelioma)from the scar of a burn. 17- Ulceration and Fistula x-rays or electric desiccation may be successful. If these fail free extirpa-tion and removal of the anatomically related glands may cure the a more advanced case, even if an extremity is involved, try the .r-ray orelectric desiccation. If this treatment does not cause rapid and decidedimprovement, amputate and clear out the related lymphatic area. In a very
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