Many chronic suppurative lesions such as chronic osteomyelitis and chronic leg ulcers are well known for their potential for malignant transformation into squamous cell carcinoma [69, 70]. The resultant tumours are known as Marjolin's ulcers, named after Marjolin's first description in 1826 . Such tumours have been described in HS.
scribed in women [5, 53, 54, 74, 85, 88, 91, 92]. This may however partly be explained by reporting bias. For instance, vulval squamous cell carcinomas may well be under-reported in association with HS, as this diagnosis was explicitly excluded from Mora's series of squamous cell carcinoma in a black population. Predisposing factors are rarely searched for in the literature. The occurrence of non-skin cancers suggests that general carcinogens such as tobacco may play a role. Some authors have suggested that skin cancers predominate in the perineal region [52, 82], which raises the possibility of co-carcinogenic factors such as human papilloma virus (HPV) [52, 87, 88] and/or past radiotherapy [72, 88]. The presence of these factors and other known carcinogen exposure should reinforce vigilance and encourage physicians to perform a biopsy in any case of suspicious HS lesions.
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