Marjolin’s ulcer arising in recurrent varicose vein ulcer after Trendelenburg operation

Chronic venous ulcers are a well-recognized complication of longstanding venous hypertension; however, malignant transformation into Marjolin’s ulcer is rare and often under-recognized. We report a 59-year-old man with a history of saphenofemoral ligation who developed a recurrent, non-healing venous ulcer over the dorsum of the left foot. Over time, the ulcer demonstrated progressive induration, contact bleeding, and failure to heal despite appropriate care, prompting biopsy. Histopathology revealed squamous cell carcinoma arising within a background of chronic venous ulceration. The patient underwent wide local excision with a 1-cm margin, excision of recurrent varicosities, and split-thickness skin grafting. Margins were free of tumor, and no nodal or distant metastasis was detected. This case highlights the importance of maintaining a low threshold for biopsy in recurrent or atypical venous ulcers, particularly following prior venous surgery, and emphasizes vigilant long-term surveillance for both oncologic and venous disease recurrence.