<p>Cutaneous squamous cell carcinoma (cSCC) is the second most common malignant skin tumor in Caucasian populations and occurs predominantly on sun-exposed areas of the body. In Germany, which has a nationwide skin cancer screening program, cSCC is usually detected in early tumor stages and can curatively be treated by surgical excision. We report the case of a 59-year-old man who had a giant untreated cSCC of the scalp and died from the local and systemic effects of the aggressively growing tumor. A subsequent medicolegal autopsy was performed. It is noteworthy that the patient had refused medical therapy throughout his lifetime despite the prominence of the tumor. Embarrassment, fear of stigmatization, and denial of the disease itself, as a coping mechanism for self-protection, are possible explanations for giant tumors not being treated, leading to a heightened importance of psycho-oncology in modern cancer therapy to ensure that the mental health of the patient remains intact.</p>