Scalp cooling with gel packs was used to try to prevent alopecia in 31 patients being treated with doxorubicin (Adriamycin), 29 for advanced breast carcinoma and two for carcinoid tumour. Twenty-eight of the 31 patients tolerated the procedure well, and 22 of these had either no hair loss or only slight loss which remained acceptable and did not require a wig. The main factor limiting success was biochemical impairment of liver function, which occurred in nine patients; of these, six had severe or total alopecia despite scalp cooling. Conversely, the technique was successful in all 19 patients with normal liver function. Carried out properly, this simple and effective technique greatly diminishes socially unacceptable alopecia associated with doxorubicin, and merits wider use.