Large upper-third auricular defects present complex reconstructive challenges, requiring restoration of both form and function. We describe a single-stage technique combining an ipsilateral conchal cartilage graft for structural support with a tunnelized preauricular transposition flap for soft tissue coverage. This approach provides rigid support to enable the use of glasses and hearing aids, along with good color and texture match. In a 79-year-old patient with a 30 × 28 mm post-Mohs surgical defect, the method yielded a satisfactory outcome with preserved ear contour and function. Only minor issues, such as slight forward auricular displacement, were noted at 8-month follow-up.

Keywords: Mohs Surgery; Dermatologic Surgical Procedures; Carcinoma, Basal Cell