Purpose. To describe ecthyma gangrenosum (EG) characteristics and complications in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes. Methods. EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. Results. EG occurred in 38 children (male/female 16/22; median age 5.2 years) with hematological malignancy (33), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3). The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (34), Stenotrophomonas maltophilia (3) and Escherichia Coli (1); 31% of them were MDR. All patients received antibacterial treatment while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were: severe neutropenia (97.3%), corticosteroid treatment (71%), iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with KPC co-infection, 3 due to the underlying disease. Conclusions. EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic evolution. The occurrence of scarring sequelae might affect the quality of life of patients.