Malignancy in chronic wounds is not uncommon and has been reported as occurring in chronic scars of diverse causes. We report an unusual case of bilateral thermal injuries of the lower extremities that 40 years later presented as very large, painful, fungating wounds of both lower legs. After histologic confirmation of squamous cell carcinoma, eradication of the disease required amputations of both the lower extremities and reconstructive procedures. In addition, we discuss current theories regarding the mechanism of malignant degeneration in chronic wounds and evaluate treatment on the basis of information currently available in the literature.