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Marjolin's ulcer is a rare but aggressive malignant transformation arising in chronic wounds or scars. We report the case of a man in his 60s who developed a large, non-healing ulcer at the site of a previous traumatic injury and reconstructive surgery performed three decades earlier. Clinical suspicion of malignancy led to wide local excision with sentinel lymph node biopsy, followed by staged reconstruction. Negative pressure wound therapy (NPWT) was used to optimise the wound bed, which was complicated by a local infection requiring targeted antibiotic therapy. Subsequent split-thickness skin grafting achieved complete graft take and satisfactory functional outcome. Histopathology confirmed well-differentiated squamous cell carcinoma with clear surgical margins. This case highlights the importance of early biopsy of chronic ulcers, multidisciplinary management and the role of NPWT in facilitating successful reconstruction after oncological resection.