One day before his death, a 66-year-old man who had been suffering since childhood from a severely itching and repeatedly bleeding skin lesion was examined for the first time by a general practitioner who immediately advised hospitalization. On admission, an extensive rodent ulcer on his back was noted and septic shock diagnosed. Because of the hopeless diagnosis no life-supporting measures were undertaken. Postmortem examination revealed an 18 x 26 cm sized ulcerating basal cell carcinoma on the back with infiltration of the thoracic vertebrae and a fist-sized paravertebral abscess between the left upper and lower lobe of the lung and abscessing pneumonia. Two metastases each were found in the right lung and in both kidneys with the histologically characteristic picture of basal cell carcinoma. This case confirms the observation that this type of carcinoma has the potential for metastasizing, but it usually does not do so because of its biological characteristics and early curative excision.