Several risk factors are generally accepted to portend more aggressive behavior of cutaneous squamous cell carcinoma. These include tumor size, tumor depth, histologic subtype, location on the lip or ear, tumor arising in scar, recurrent tumor, and tumor demonstrating perineural invasion. Organ transplant recipients can have significant morbidity and mortality from squamous cell carcinoma. Observations: Four organ transplant recipients devel-oped metastatic disease from squamous cell carcinoma

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... f the scalp. Conclusions: Squamous cell carcinoma of the scalp in organ transplant recipients should be considered a highrisk tumor because of its anatomic location. Margincontrolled tumor extirpation, sentinel lymph node biopsy, and adjuvant radiation therapy should all be considered in the organ transplant recipient population.