T1 MP-RAGE 3D weighted sagittal contrast-enhanced MRI sequence before definitive radiotherapy. MRI showed a 7.2 × 6.8 × 5.5 cm tumor with destruction of the skull and suspected infiltration of the dura mater and superior sagittal sinus. Biopsies showed cutaneous squamous cell carcinoma. The TNM stage was cT. 4a cN0 cM0, stage IVA using the Union for International Cancer Control (UICC) staging system (8th edition).