Background: Giant basal cell carcinoma (BCC) is a rare and locally aggressive variant of the most common cutaneous malignancy. It often arises due to delayed diagnosis and can present 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 defect was reconstructed using a fasciocutaneous transposition flap. The patient had an uneventful recovery and no signs of recurrence on follow-up.
Conclusion: This case highlights the importance of clinical awareness regarding atypical presentations of BCC. Early recognition and a multidisciplinary approach are essential to achieving optimal oncologic control and functional reconstruction, even in rare and complex presentations.