Background: Basal cell carcinoma is the most common cutaneous malignancy. Nasal location and infiltrative histology are high-risk features because of the potential for subclinical extension, incomplete excision, and local recurrence. Excision of extensive lesions may create defects involving several nasal subunits, requiring reconstruction with tissue that provides reliable vascularity and an appropriate color, texture, and thickness match. Case presentation: A 92-year-old man with no relevant medical history presented with a lesion on the nasal dorsum that had been present for more than 5 years. Skin biopsy demonstrated solid infiltrative basal cell carcinoma. Examination revealed an infiltrated erythematous plaque with crusting, irregular poorly defined borders, and extension toward both medial canthi. Wide surgical excision was followed by immediate reconstruction using a pedicled forehead flap, a right nasolabial flap, and advancement of left nasal skin. During early follow-up of less than 30 days, the transferred tissues remained viable, with no clinically evident necrosis, infection, or wound dehiscence.