Locally advanced basal cell carcinoma (BCC) is an uncommon and complex presentation of BCC. These tumors can present as extensive nonhealing ulcers and require skin biopsy to rule out other causes, including malignant, infectious, and inflammatory etiologies. In this case report, a 57-year-old female without significant past medical history presented with a 5-year history of a chronic progressive ulcer involving the neck and back. Histopathological study of the tissue identified nodular and infiltrative BCC, prompting further multidisciplinary treatment and management with vismodegib, radiation, and surgery.