Background:Patients with locally advanced skin cancer often present an uncommon and unique treatment challenge. Surgical resection and reconstruction with an acceptable cosmetic outcome is difficult for larger lesions with deep infiltration into subcutaneous tissues. Radiation therapy has been shown to be an effective treatment modality for advanced non-melanoma skin cancers, with cure rates ranging 50-100%. In this case report, we discuss the efficacy and outcome of treatment using an advanced radiation therapy technique to a large T4 squamous cell carcinoma of the face.Main observations:The patient responded favorably to the advanced radiation treatment course, and achieved a clinical complete response to therapy. No further intervention was required. Advanced radiation therapy techniques offered treatment advantages that resulted in greater tumor dose escalation and minimizing of patient morbidity.Conclusions:Patients with advanced skin cancers of the head and neck should be considered for definitive radiation therapy using advanced treatment techniques. The use of definitive RT only for tumors deemed unresectable, or for inoperable patients at presentation deserves reconsideration. Further investigation is warranted.