Despite squamous cell carcinoma being one of the most common skin cancers in the UK,1 atypical presentations can lead to delayed diagnosis and management. Here, we present a 67-year-old man who had spent a considerable period of his adult life in the Congo as a gold prospector, referred to us by the dermatology team. The man reported an insect bite that had developed into a chronic ulcer of his left forearm sometime in the early 1990s. The ulcer had been managed conservatively for over 15 years in primary care without ever completely resolving; however, over the past year, it had rapidly developed into a large fungating mass encompassing the majority of the left forearm (figure 1). The wound was discharging pus and had an offensive odour that the patient reported was requiring daily dressings in the community to manage. The patient reported that...
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