Scalp hypothermia has been introduced to reduce the temporary epilation associated with certain cytotoxic drugs. This has improved compliance with drug delivery for some patients. It is currently not recommended for use in those tumors with a high prevalence of scalp metastasis, ie, leukemia and lymphoma. We have treated a patient for mycosis fungoides who demanded use of a "cooling cap" while undergoing consolidation chemotherapy. Cutaneous disease recurred on the scalp, with no other evidence of mycosis fungoides. Caution should be used in reducing drug delivery to the scalp while treating tumors manifesting cutaneous stem cell tumor nests.