A 72-year-old man with advanced locally invasive basal cell carcinoma of the forehead failed several pretreatments including surgery and radiation. MRI was not feasible because of the presence of facial implants. CT scan did not provide clear evidence of vital/avital tumor sites as a result of slow progression and previous radiation treatments. Due to limited treatment options, the patient underwent evaluation with 68 Ga-OncoFAP PET/CT for potential stereotactic body radiation therapy. We present a rare case of advanced and metastasized basal cell carcinoma with vigorous FAP (fibroblast activation protein) expression.