A patient had metastatic basal cell carcinoma of the right upper eyelid and periorbital area. Initially treated with radiation, there were multiple, extensive local recurrences requiring wide surgical excision. Ten years after the first lesion appeared, a metastasis was found in the preauricular soft tissue. A literature search found 204 previously reported cases of metastatic basal cell carcinoma, but none in the Western or European ophthalmic literature. The pathogenesis and unique features of basal cell carcinoma behavior are discussed.