Squamous cell carcinoma arising in long‐standing hidradeniti
A 45‐year‐old man presented with a large haem‐crusted ulcer involving the right side of the buttock for 2 months (a). The lesion was painful with purulent secretions. The patient had hidradenitis suppurativa, Hurley stage III, over his bilateral buttocks for 15 years. He had been treated with different oral antibiotics, isotretinoin and intralesional corticosteroids, but without improvement.

Histopathology showed mild‐to‐moderate nuclear atypia with abundant pink cytoplasm, well‐developed keratinization and keratin pearls (b; original magnification × 100), supporting the diagnosis of well‐differentiated squamous cell carcinoma.

Positron emission tomography revealed metastasis to diffuse areas over the posterior neck, chest wall, abdominal wall, liver, bilateral thighs and pelvic floor (c). The patient received concurrent radiochemotherapy but died after 6 months.

Major takeaway:-

- The development of squamous cell carcinoma from chronic and severe hidradenitis suppurativa is a rare and easily overlooked complication that may change a potentially curable disease into a lethal one.

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