Subcutaneous Basal Cell Carcinoma of the Cheek: A Diagnostic Pitfall

Background Subcutaneous basal cell carcinoma (BCC) is a rare subtype of BCC. We present a case of primary deep-seated BCC on the cheek to highlight the diagnostic challenges and surgical management of this atypical presentation. Case Presentation A 58-year-old male with no history of skin malignancy presented with a subcutaneous cheek mass. Excisional biopsy revealed BCC involving the deep soft tissue with positive deep margins for residual tumour. Management and Findings The patient subsequently underwent a formal re-excision and received adjuvant radiotherapy. Histopathology confirmed an infiltrative growth pattern within the subcutaneous fat. The patient was lost to follow-up following adjuvant radiotherapy. Conclusions This case underscores the importance of considering BCC in the differential diagnosis of subcutaneous facial masses. The proposed histogenesis is either that of a deep follicular or sebaceous unit origin. For plastic surgeons, achieving clear deep margins is paramount to preventing recurrence in these rare and occult presentations.