History: This lady had left this lesion to grow over a 4 year period before seeking any medical attention.She was of greater than average intelligence and was aware she had a problem but only sought medical attention when the lesion began to smell.It was an aggressive basal cell skin cancer. At surgery it was down to and involving the muscle of the chest wall.The defect was partially closed primarily with a split skin graft used  for the rest.A BCC of this size and nature is most unusual nowadays.It used to be known as BCC tenebrens.