Malignancy in a chronic pressure sore is rare among Marjolin’s ulcers. Carcinomas arising in pressure sores are highly aggressive and usually fatal and therefore, they need to be treated more aggressively. We report a case of squamous carcinoma arising in a pressure sore of a 33-year-old paraplegic man who developed a sacral pressure sore with unstable healing for 10 years and a steady increase in size in the past 6 months was noted. The biopsy result showed a well differentiated invasive squamous cell carcinoma. A high index of suspicion is necessary for long standing pressure ulcer in this frequently neglected group of people to enable early diagnosis and treatment.