Marjolin’s Ulcer in Patients With Anogenital Lichen Planus: A Systematic Review
Bibliographic record
Abstract
Anogenital lichen planus (ALP) is a chronic inflammatory condition associated with significant morbidity and a potential risk of cutaneous squamous cell carcinoma (cSCC), specifically Marjolin ulcer (MU), a rare, but aggressive, life-threatening complication. This systematic review aimed to describe the clinical characteristics of patients developing MU within ALP and its treatment outcomes. MEDLINE and Embase (inception-November 2024) were searched, identifying studies reporting MU or squamous dysplasia arising within ALP lesions. Thirty-two studies (n = 176 cases) were analyzed, including cohort studies, case series, and reports, and a descriptive analysis was performed. Patients had a mean age of 63.9 years, with 77.3% female. ALP lesions were most commonly vulval (72.2%) in females and penile (22.2%) in males. MU or cSCC precursor prevalence in ALP cohorts ranged from 0.9% to 4.2%. Human papillomavirus was rarely detected (8.4%), suggesting other mechanisms underlying MU development. The mean ALP duration prior to squamous dysplasia was 47.5 months. Metastases were present in 45.7% of cases that reported this outcome. MU treatment primarily involved surgical excision, with recurrence in 32.9% of cases and mortality in 21.1%. Poor disease control, erosive morphology, and long-standing lesions were associated with higher malignancy risk. Overall, this review highlights the malignant potential of ALP and underscores the importance of early detection and multidisciplinary care. Routine anogenital examinations, timely biopsies of suspicious lesions, and aggressive management of ALP may improve outcomes. Further research is needed to elucidate the mechanisms underlying MU development and optimize treatment strategies for this rare but morbid complication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".