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Warfarin-induced skin necrosis (WISN) is a rare but serious adverse effect of warfarin that typically occurs during the initial days of therapy. However, late-onset WISN, occurring months or years after stable anticoagulation, is an unusual and poorly understood phenomenon. Here, we present a case of WISN that had presented after 5 years of stable anticoagulation. This research highlights the significance of clinical suspicion, prompt intervention and customised anticoagulation methods for patients on warfarin therapy who present with unexplained necrotic skin lesions.