BCC is the most common form of skin cancer. It occurs mainly on light-exposed sites, most commonly on the faces of the middle-aged or elderly. Prolonged sun exposure is the main factor. BCCs arise from the basal keratinocytes of the epidermis, are locally invasive, but very rarely metastasize. The slow but relentless growth destroys tissue locally (can invade underlying cartilage or bone or damage important structures). The recurrence rate is about 5% at 5 years for most methods of treatment. Follow-up is particularly important if there is concern about the adequacy of removal. This woman has been diagnosed as BCC of the scalp 3 years ago treated with curettage and cautery at that time. After 2 years of treatment a new ulcer appeared at the site of previous treatment and within one year a rodent ulcer with a rolled up irregular border of about 7 cm diameter was established.