We describe a case of basal cell carcinoma (BCC) in a 36-year-old lady. She had a history of recurrent BCC in the ventral aspect of her right forearm. She presented to our hospital with her third recurrence of skin lesions in the same location. Histopathological examination of the skin revealed the features of BCC with evidence of perineural invasion (PNI). She underwent a margin-free, wide local excision, vacuum-assisted closure of the wound, and reconstructive surgery using a skin graft. She also underwent a sentinel lymph node biopsy (SLNB), which was negative for the tumor. Then she was referred for radiotherapy. Although the patient underwent a free-margin excision in the previous episodes, she came back years later with a recurrent lesion.It is considered that basal cell carcinomas larger than 3 cm in size with perineural invasion evidence on histopathological examination and with deep tissue involvement have a bad prognosis compared with the smaller superficial lesions. Thus, based on the findings in our case and the previously reported cases, careful follow-up is recommended for patients with BCC with bad prognostic factors. In certain high-risk cases, SLNB should be considered to rule out occult metastasis.