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The development of a pressure sore carcinoma in scars of spinal cord injury patients is a rare event (less than 0.5%) and occurs late (more than 30 years after the spine injury) but the prognosis is very poor. Five cases are reported and different aspects are reviewed: anamnesis, clinical features, and follow-up studies. The association of surgery and radiotherapy is usual but is not very successful. Local-regional chemotherapy and a better approach concerning immunological mechanisms may improve survival. Scar prevention and surgical management of chronic scars treated unsuccessfully by medical methods are the best means to prevent malignant changes in chronic pressure sores. Biopsy should be mandotory for all pressure sores after the first decade.