Background: Surgical management for neglected basal cell carcinoma (NBCC) involves wide excision and removal of surrounding infiltrated structures; thus, a multidisciplinary approach is required to minimize postoperative functional and cosmetic impairment, including the use of flaps. We report a NBCC wide excision with anterolateral thigh (ALT) microvascular flap reconstruction in a tertiary care hospital in Sumatra, Indonesia. Case presentation: A 62-year-old woman presented with temporal lump since the last 12 months, accompanied by progressive hearing loss and facial nerve paresis. Physical examination revealed a 20x18 cm fixed lump with indistinct borders in the left temporal region, necrotic area of auricular cartilage, and N.VII paresis. Contrast CT-scan demonstrated tumor infiltration of the parotid gland, left zygomaticum bone with cortex erosion, left temporal muscle, and the cortex of lateral ramus of left mandibular bone. Tumor excision was performed at a distance of 1-1.5 cm from the edge of the lesion, followed by parotid radical resection without preserving the fascial nerve. A craniotomy was also performed which was closed with titanium mesh. Pathological examination revealed nodular basal cell carcinoma with vascular invasion. The excised area was closed with a 20x10cm ALT flap. The lateral femoral circumflex artery and vein were anastomosed with the fascial vasculature. Evaluation on day-2 show no good flap attachment with no complication. Conclusion: ALT flap microsurgery reconstruction offers good functional and cosmetic outcomes following resection of NBCC which leaves extensive structural defects.