Skin cancers originating in areas of chronic injury (Marjolin's ulcers) are thought to behave in a more aggressive fashion than those due to other causes. The initial surgical treatment, especially the management of the regional lymph nodes, remains controversial. This review of 37 patients with Marjolin's ulcer evaluated the effectiveness of local surgical treatment at our center. Three of 18 patients treated with amputation developed recurrences and died of metastatic disease. Five of 16 patients treated by wide excision developed recurrences, two dying with metastatic disease, the remaining three apparently cured by additional surgery. Only six (17.6%) of the patients treated by "local" modalities, i.e., wide excision or amputation, developed subsequent regional node metastases. Recurrences following local excision tend to be local and can usually be managed by re-excision or amputation. It can be inferred from this study that prophylactic node dissections are not required in most patients with Marjolin's ulcers.