Background: Squamous cell carcinoma (SCC) is a common skin cancer frequently managed by plastic surgeons. It can be aggressive, requiring timely treatment to prevent progression to advanced stages. Managing SCC in frail patients is challenging due to risks associated with general anaesthesia, such as postoperative cognitive decline. Identifying surgical techniques that minimise anaesthetic burden while maintaining effective local control should be attempted to prioritise patient safety. Case Report: An elderly, underweight gentleman with a complex medical history presented with a 5 cm fungating squamous cell carcinoma (SCC) on the scalp. His comorbidities made him a high-risk candidate for general anaesthesia, while his low body mass index (BMI) posed challenges for performing larger procedures, such as a scalp flap, under local anaesthesia due to the limited amount of anaesthetic that could be safely administered. To address these concerns, a single-stage procedure was undertaken, involving wide local excision and the application of a Biodegradable Temporising Matrix (BTM). Discussion: This approach eliminated the need for a traditional two-stage reconstruction, successfully sparing the patient from an additional operation. This patient was closely followed up in the outpatient setting confirming an aesthetic outcome. This case demonstrates the importance of tailoring surgical strategies to individual patient needs, particularly for frail patients with complex medical histories while still prioritising oncological clearance and reconstructive outcomes.