BACKGROUND Overcoming the unique anatomical challenges posed by mid-temporal defects due to Mohs micrographic surgery treatment of various skin cancers can be difficult. Additionally, the decision-making process in selecting the most appropriate approach to achieve functional and aesthetic outcomes can require analytical reasoning. The vulnerability of the temporal branch of the facial nerve becomes relevant when surgical procedures are conducted in proximity to its most superficial region, just over the zygomatic arch. For small defects, second intention and primary closure methods are applicable. However, in terms of large temporal defects, Mohs micrographic surgery can provide the optimal result for patients. CASE REPORT We report a 68-year-old man who presented with a 4.2-cm invasive, well-differentiated squamous cell carcinoma with rapid growth and poorly defined borders in the left mid-temporal region. This tumor was treated with Mohs micrographic surgery and cleared in 5 stages. The local flaps reconstructive technique was used to optimize patient outcomes. CONCLUSIONS For large temporal defects, primary closure may not be feasible, due to the limited elasticity of skin in this region. As such, reconstructive techniques, including local flaps, skin grafts, or a combination of these approaches can be considered. A V-Y advancement flap is a reconstructive technique that can be used for a large mid-temporal defect, while preserving functional and aesthetic elements for patients. The success of this technique depends on the maintenance of flap viability through careful flap planning, anatomical landmarks, dissection, and vascular pedicle preservation.
