Background. Radiotherapy for tinea capitis was widely used in the 1930s and 1940s. There is a fourfold increase in the risk for developing nonmelanoma skin cancer in the scalp. Excision of lesions is challenging, as tissue around the wound is atrophic and susceptible to ischemia. Objective. To discuss the risk of skin cancer in the older patient who received scalp radiotherapy in childhood and options for scalp reconstruction after excision. Methods. A woman developed squamous cell carcinoma on the scalp 67 years after radiotherapy for tinea capitis. Results. The large excision defect was successfully grafted, avoiding the need for complex scalp reconstruction. Conclusion. Patients who received scalp radiotherapy in childhood are at increased risk of developing nonmelanoma skin cancer. The unique anatomy of scalp tissue makes it difficult to close excisional defects. Skin grafting often fails, and complex flaps or the importation of vascularized tissue may be required. D. N. RONEL, MD, FAAP, R. G. SCHWAGER, MD, FACS, AND M. R. AVRAM, MD, FAAD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.