An 82-year-old white man underwent Mohs micrographic surgery for treatment of a squamous cell carcinoma on the left side of his forehead in September 2002. The tumor was completely excised in 4 stages. The resultant 7.2 × 7.0-cm partial-thickness defect was allowed to heal by second intention. Initially, the wound care treatment consisted of biweekly wound cleansing with isotonic sodium chloride solution and dressing change with Aquaphor ointment (Beiersdorf Inc, Wilton, Conn), Telfa pads (Kendall, Mansfield, Mass), and Hypafix tape (BSN Medical Inc, Charlotte, NC). Although there was reepithelialization at the periphery of the defect after a 6-month period, the central portion of the wound had areas of persistent nonhealing ulceration and hypergranulation tissue. The area of ulceration and hypergranulation did not respond to treatment with fluocinonide ointment, 0.05%, under occlusion; repeated chemical debridement with trichloracetic acid, 35%; Protopic ointment, 0.1% (Astellas Pharma US Inc, Deerfield, Ill); or a 3-month trial with becaplermin gel. This situation did not change significantly for 3 years.