Background: Basal cell carcinoma (BCC) of the skin is the most common cancer, with a higher incidence than all other malignancies combined. Although it is rare to metastasize, patients with multiple or frequently recurring BCC can suffer substantial co-morbidity and be difficult to manage. The medial canthal region is a common site for tumors, particularly basal cell carcinoma. Case description: Surgical approaches often offer the most effective and efficient. Medial canthal reconstruction following skin cancer excision presents a challenge to the surgeon because of the complex anatomy and the difficulty in obtaining tissue of the appropriate color and thickness. There are several options available for reconstruction of the medial canthal region including healing by secondary intention, full-thickness skin grafts, and local or regional flaps. Skin grafting can provide well contoured and esthetically acceptable results. Skin graft can be harvested from upper and lower eyelid, retro auricular, supraclavicular and preauricular region. We reconstructed medial canthal defect using graft from preauricular region as patient was old with enough lax skin and wrinkles on face. Conclusion: Various skin graft techniques can be used for reconstruction of large superficial defects that involve medial canthal area. But preauricular skin graft is a useful technique that has good cosmesis and minimal postoperative complications.