Background: Giant basal cell carcinoma (BCC) is a rare, locally aggressive variant of the most common cutaneous malignancy. It often develops due to delayed diagnosis and may occur in atypical, sun-protected areas, making clinical recognition more challenging.
Case Report: An 82-year-old male presented with a 12 × 8 cm ulcerated lesion in the posterior axillary region, an uncommon and sun-protected location. Surgical excision was performed with clear margins, and the resulting defect was reconstructed using a fasciocutaneous transposition flap. The patient’s postoperative course was uneventful, with no signs of recurrence on follow-up.
Conclusion: This case underscores the importance of clinical vigilance for atypical presentations of BCC. Early recognition, combined with a multidisciplinary approach, is essential for achieving optimal oncologic control and functional reconstruction, even in rare and complex presentations.