Advanced skin cancer of the head and neck is best managed by a multidisciplinary approach. The goal is to control the malignancy while maximizing function and aesthetics, and hence the quality of life, after therapy. As a member of the patient care team, the reconstructive surgeon brings specialized expertise in modern techniques of tissue transfer to provide the optimal restoration for patients following resection of the tumor. Microvascular surgery represents the current technical state of the art for reconstruction in these patients with advanced lesions.