Basal cell carcinoma（BCC）is usually found and treated when it is small, whereas the giant type is rare and difficult to treat. We present one case of giant BCC that was reconstructed using the anterolateral thigh flap（ALT）. A 60-year-old man presented with giant BCC on his face. The tumor was 70×65 mm, and covered the right lower eyelid, cheek, nose and upper lip. Wide resection of the tumor involving the nose cartilage, nasal bone, maxillary bone and zygomatic bone partially was performed first. Secondary reconstruction using the ALT was carried out after pathological analysis, which confirmed margin-free status. The outer cheek skin and inner nasal lining were covered with a partially de-epithelized flap. Microvascular anastomosis between the pedicle of the flap and the right facial vessels was performed in an end-to-end manner. Six months after reconstructive surgery, revisional surgery was performed. The flap-in-flap technique was used according to the facial aesthetic unit concept. Costal cartilage grafting between the outer skin and inner lining was effective to prevent the lack of nasal ventilation. There were no signs of tumor recurrence at 30 months of follow-up, and the patient was satisfied with his appearance and function.
