49 year old man with a history of a 95% BSA full thickness flame burn from a gas explosion 15 years earlier. The only unburned parts were his feet, his hands and the volar part of the left forearm. numerous skin grafts had been taken from his left forearm for surgical expansion and grafting. He also received Cultured Epithelial Autografts on both legs. He had had many skin breakdowns particularly on his legs. The current one over his left popliteal fossa and adjacent posterio-medial thigh and lower leg showed areas of shin breakdown and surrounding hyperkeratotic areas. These areas had initially been grafted with Cultured Epithelial Autografts. Punch biopsies were taken in order to rule out malignancy. These biopsies showed verrucous (squamous) carcinoma. A resection with a 2cm macroscopic margin was done. The resected specimen was 22 X 6cm. Permanent section section pathology showed clear margins and he was taken to the operating room two days later for grafting with expanded split thickness skin grafts under local anesthesia as an outpatient.