(a) Incision design to allow for wide local excision (1 cm margins) of recurrent MCC with concomitant superficial parotidectomy, selected neck dissection, and microvascular reconstruction. (b) Completion of ablative surgery and cervical lymphadenectomy, noting distal temporal facial nerve involvement. Final pathology indicated negative margin resection. There were no cervical or parotid lymph node metastasis present on final pathologic examination.