A case of burn scar carcinoma was reported. A 65-year-old man discovered a finger-sized mass on the top of his head 4 months prior to his first visit to our department. He came with a fist-sized tumor and an ulcer of the same size beside it. He had a burn scar caused 60 years ago by an “iron” (Japanese hearth) . Histopathological examinations revealed squamous cell carcinoma. Cranial CT/MRI showed that the tumor was invading the brain. Metastasis to pleura, periaortic lymph nodes, and cervical vertebrae made curative excision difficult. During the course of his radiation therapy (total 42Gy), pressure fracture of the cervical vertebrae occurred, resulting in tetraparesis. Additional radiation of 33Gy was applied to his neck fracture, followed by chemotherapy using low-dose cisplatin (5mg/day, for 5 days/week) . Although the tumor was decreasing in size, a sudden onset of respiratory failure occurred, which resulted in his death 2 months after his first visit. [Skin Cancer (Japan) 2003; 18: 75-79]