In an elderly man bilateral temporal scalp necrosis complicating temporal (systemic giant cell) arteritis developed. The patient also demonstrated other features characteristic of this entity: (1) exquisite scalp tenderness and headache, (2) onset late in life, (3) visual disturbances, (4) general debility, (5) diagnostic temporal artery biopsy, and (6) gradual healing with glucocorticosteroid therapy. A computer assisted review revealed 13 similar cases of scalp necrosis associated with temporal arteritis published in the English literature.