Big Bad BCCs: craniofacial resection and reconstruction for atypical basal cell carcinomata

Basal cell carcinoma (BCC) is the most common malignancy of the body and most frequently occurs in the head and neck. 'Problematic aggressive' BCCs are either frequently recurrent, often after histologically confirmed clearance, or are 'giant/horrifying' and invasive of critical anatomy. Three patients that illustrate different clinical features and outcomes of 'problematic aggressive' craniofacial BCCs are reported that required craniofacial resection and reconstruction with microsurgical free flap cover, and a re-evaluation of our care pathway for these uncommon presentations.