Squamous cell carcinoma in long standing hidradenitis suppurativa a case report with a review of the literature

Hidradenitis suppurativa (HS), also known as Verneuil’s disease, is a chronic inflammatory skin disorder characterized by recurrent nodules, abscesses, sinus tracts, and progressive scarring. Although the disease is benign, long-standing HS may rarely undergo malignant transformation into squamous cell carcinoma (SCC), a complication associated with poor prognosis and high mortality. We report the case of a 42-year-old man with a 27-year history of multifocal hidradenitis suppurativa involving the axillary, inguinal, and anoperineal regions. The patient presented with a progressive ulcerated lesion of the anoperineal region associated with chronic purulent discharge and intermittent bleeding. Clinical examination revealed a large irregular ulceration arising on a background of fibrotic scars and sinus tracts related to long-standing HS. Histopathological analysis following biopsy confirmed a well-differentiated squamous cell carcinoma developing on hidradenitis suppurativa lesions. After multidisciplinary evaluation, the patient was referred to oncology and treated with combined chemoradiotherapy. To contextualize this observation, a literature search of PubMed/MEDLINE, Scopus, and Google Scholar was performed using the terms ("hidradenitis suppurativa" OR "Verneuil disease") AND ("squamous cell carcinoma" OR "malignant transformation"). Relevant publications reporting histologically confirmed SCC arising in HS were reviewed and narratively synthesized. A total of 21 studies were included in the qualitative synthesis. Reported patients were predominantly male (~85%), with a mean age of approximately 54.6 years and a mean disease duration of 24.3 years before malignant transformation. The anogenital and perineal regions were the most frequently affected sites. Aggregated mortality rates approached 31%, reflecting the aggressive nature of this complication. Squamous cell carcinoma represents a rare but life-threatening complication of long-standing hidradenitis suppurativa. Because early malignant transformation may mimic inflammatory HS lesions, diagnosis is frequently delayed. Persistent ulceration, bleeding, or rapidly enlarging lesions should prompt early biopsy. Close surveillance of patients with severe, long-standing HS is essential to enable early detection and improve outcomes.