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CD: Crohn’s disease HS: hidradenitis suppurativa SCC: squamous cell carcinoma TNF: tumor necrosis factor INTRODUCTION Cutaneous squamous cell carcinoma (SCC) is an invasive, malignant tumor with metastatic potential. This tumor can arise from various precursor lesions, including ulcers, actinic keratoses, and leukoplakia. A Marjolin ulcer is an aggressive malignancy of the skin, most commonly SCC, arising in chronic wounds or scars. Transformation from a chronic wound to SCC is rare and slow with an unknown pathogenesis, although proposed mechanisms include nonspecific or chronic antigenic stimulation. Malignantly transformed wounds are challenging to differentiate from primary chronic ulcers, so having a high suspicion for SCC and diagnosis in a timely manner is key. Clinically, it is important to monitor for changes in wound appearance and perform histologic evaluation early. Chronic osteomyelitis is the clinical condition most frequently associated with Marjolin ulcers, with other common etiologies being trauma, burns, and diabetes. Although cases of SCC developing in the setting of chronic hidradenitis suppurativa (HS) or Crohn’s disease (CD) have been described in the literature, SCC may be regarded as a rare complication of these diseases. We present a patient with chronic cutaneous CD that worsened focally on the gluteal cleft and perineum that then became refractory to multiple immunosuppressive therapies, including biologics and cyclosporine. After months of failed treatment, she was found to have SCC, and ultimately passed away approximately 18 months later.

Squamous cell carcinoma arising in a chronic perineal wound in a patient with long-standing cutaneous Crohn's disease