Aggressive Basal Cell Carcinoma of the Head Reconstructed with Free Flap: A Case Report

Basal cell carcinoma (BCC) rarely invades bone, presenting surgical challenges. We report a 5×5 cm ulcerated and orocutaneous fistulous BCC with invasion of the anterior maxillary wall, infraorbital nerve, and adjacent soft tissues. The lesion was excised with planned clear margins. Intraoperative findings confirmed invasion into the upper gingivobuccal sulcus, anterior maxillary wall, and infraorbital nerve. A maxillary segmental resection was performed. The resulting defect was reconstructed using a Bichat’s fat pad flap, while a radial forearm free flap restored mucosal lining and external contour. The mucosal lining was successfully reconstructed, the orocutaneous fistula closed, and the skin contours effectively restored due to the pliability and versatility of the radial forearm flap. Extensive BCC with bone invasion can necessitate a surgical approach involving free flap reconstruction to achieve favorable functional and aesthetic outcomes. Early recognition and multidisciplinary approach are essential for optimal results.