Basal cell carcinomas (BCCs) of the lower extremities are not frequently reported. Some pre-existing or predisposing conditions are thought to be implicated in their development. In this study, we investigated the possible relationships between pre-existing cutaneous changes and the development of BCCs of the lower extremities, possible sex and age differences, and the histologic patterns involved. Among 1053 patients with BSSc, BCCs of the lower extremities were observed in 48 (4.5%): 25 men and 23 women. Lesions appeared on the thighs (16 cases), the lower legs (27 cases), or the feet (5 cases). Histologic patterns were nodular and micronodular (18 cases), superficial (27 cases), or infiltrative (3 cases). No differences were observed between sexes. The relative degree of elastosis was higher in the lower limbs of women than of men (2.25 vs 1.53). Pre-existing cutaneous changes were observed in 7 cases. The frequency of these BCCs of the lower limbs and the higher degree of elastosis observed in the women seem to be related to sun exposure. The histologic pattern seems not to be affected by environmental factors but rather characteristic of body site. Pre-existent cutaneous changes are not thought to be possible etiologic factors.