The treatment of neglected locally advanced non-melanomatous skin cancers of the head and neck are an uncommon and unique therapeutic challenge.  A patient may decline aggressive surgery and reconstruction if it is feasible and recommended for the same complex reasons that they did not seek medical attention in the first place. Palliative radiotherapy is sometimes considered in such cases but the role of definitive radiotherapy is less well defined.

Here we present a case study of a man who declined surgery for a destructive and fungating basal cell carcinoma of the face involving the left eye, zygoma, frontal sinus, parotid and ear that was present for over ten years. Curative intent radiotherapy to 70Gy was delivered over 7 weeks using a complex 3D-conformal technique. The treatment was well tolerated. One year later, there is no clinical evidence of disease and the lesion has gradually healed to leave a small area of chronic ulceration. The patient is very satisfied with the result