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Four patients with recurrent, periorbital basal cell carcinoma and who ultimately required craniofacial composite orbitectomies are presented. Common clinical features included medial canthal and eyelid location of tumors, multiple previous surgical procedures, and morphealike clinical appearance of the tumor. Common histologic features included extensive, dense hyaline fibrosis and perineural invasion. Because of the extensive soft-tissue and osseous involvement, all patients required composite resection of the orbit, the ethmoidal sinus, the orbital contents, and the soft tissue of the eyelids, brow, and temporal region. This required an intracranial approach utilizing a frontal craniotomy and distant flap coverage of the resultant defect. Emphasis is placed on the early, aggressive, and complete surgical resection of such lesions, before orbital invasion has occurred, so subsequent mutilating surgery may be avoided.