The correct answer is E. Tumors arising within scars/chronic ulcers have the highest risk of metastasis.

This is SCC of the ear. SCCs arising within scars/chronic ulcers metastasize in ~30-40% of cases, whereas those arising on the lip or ear have a 10-20% risk of metastasis. Recurrent SCCs have a metastasis risk of up to 30%.

SCC is the 2nd most common skin cancer in Caucasians (BCC is most common). Oral SCC most commonly presents on the lateral tongue. SCC is typically more aggressive in patient with CLL. Organ transplant patients have a 65-fold increased risk for developing cutaneous SCC.

References:

Pekarek B et al. A Comprehensive Review on Marjolin’s Ulcers: Diagnosis and Treatment. J Am Col Certif Wound Spec. 2011 Sep;3(3):60-4. PubMed Link: