This 75 year old gentleman, had and enlarging patch of his upper forehead that would occasionally bleed and sting. Careful examination with binocular microscopy in the office identified it as a large multifocal squamous cell carcinoma. Comfortable, awake, in-office removal of the skin cancer - again using the binocular microscope - entirely removed the cancer. Immediate reconstruction with a large, bi-directional rotation flap has restored a normal-looking face with only minimal scar evidence that the cancer was ever there. He is now 4 years cancer-free and very pleased with the cosmetic result.