Introduction Microcystic adenexal carcinoma (MAC) is a rare head and neck neoplasm with significant morbidity due to its propensity for local invasion. The onset is often indolent, as ulcerated plaque or nodule. Surgical treatment is radical leading to large ablation defects, posing reconstructive challenges. Method This presentation looks at it’s history and histology as well as present the case of a 78 F who had a 3x4 cm indurated mass fixed to her maxilla. She underwent a wide local excision with partial maxillectomy and reconstruction with free flap. This was followed by radiotherapy and had good disease free survival. A retrospective case review was then undertaken from June 2004 to November 2014, looking at age, sex, treatment (surgery & radiotherapy), reconstruction and disease-free survival. Results The median age of presentation was 80 years with equal number of male and female patients. Majority (>90%) were from head and neck area except for a rare incident from hand. All underwent wide local excision with various reconstructive modality. All but one underwent adjuvant radiotherapy. Median disease free survival was 32 months, with death from unrelated causes in other patients. Conclusion MAC is a rare head and neck neoplasm which needs radical resection with its indolent onset and aggressive growth pattern. Wide resection and post operative radiotherapy, ensures disease-free survival.