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Immunosuppressive drugs are vital after solid-organ transplantation for rejection prevention but are also associated with significant complications. Malignancy as a product of immunosuppression is a common cause of posttransplant morbidity and mortality. The most common cancer in transplant patients is squamous cell carcinoma of the skin (SCCS).1 Given the rising incidence of posttransplant malignancy due to advances in perioperative care extending life expectancies, methods for addressing posttransplant SCCS merit investigation. The scalp is one area at risk for SCCS in posttransplant patients. Scalp SCCS has a propensity for being particularly aggressive, thereby necessitating equally aggressive resection to prevent progression,metastasis, and recurrence.2 The resulting scalp defect after resection is often large and challenging to reconstruct. Rotational scalp flaps and skin grafts are effective treatment modalities; however, larger defects often require free tissue transfer for adequate soft tissue coverage. We present a unique case of recurrent SCCS of the scalp and describe a novel surgical approach.

Staged Excision of Squamous Cell Carcinoma and Actinic Keratosis of the Scalp with Staged Free Flap Inset in a Posttransplant Patient