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The most common malignancy in the USA is basal cell carcinoma. It is most prevalent on the head and neck, but can occur elsewhere. We sought to determine the frequency of basal cell carcinomas arising on the lower extremities, as well as the gender of affected patients, the histologic subtype, and the specific sites of involvement.We reviewed cases submitted to the Vanderbilt Dermatopathology Service between 1994 and 1997 which were diagnosed as basal cell carcinoma. A subset of 150 cases which arose on the lower extremities and a control group of 150 cases which arose at other anatomic sites were studied further.A significantly greater number of basal cell carcinomas of the lower extremities arose in women, were of the superficial subtype, and were found below the knee; 59% of basal cell carcinomas in both sexes arose on the right limb.Basal cell carcinomas of the lower extremities occur more often in women in the USA and are of the superficial subtype. This may be due to differing patterns of dress and exposure to the sun.