72-year-old man presents with an ulcerating skin lesion on the right scalp. In March 2013, a biopsy showed pleomorphic sarcoma and the histologic differential diagnosis included atypical fibroxanthoma and malignant fibrous histiocytoma. In May 2013, Mohs excision and additional resection of the outer table of the calvarium was completed. In April 2016, a new scalp squamous cell carcinoma was treated with Mohs, and outer table of calvarium shaving and reconstruction. In October 2016, recurrent squamous cell carcinoma was treated with Mohs excision with positive margins. A head CT scan on 10/28/2016 found a lytic lesion in the right parietal bone. On 11/2/2016 excision of outer calvarium and scalp reconstruction was performed. Bone pathology showed squamous cell carcinoma invasion. Patient was referred to UCI for radical resection. While undergoing a cardiac work up for his resection, the patient developed meningitis with severe impact to his function.