Intracranial invasion by a basal cell carcinoma on the scalp is extremely rare. We present an autopsy case of a 57- year old woman who developed a large destructive basal cell carcinoma with extension through the calvarium and compression of the dura. We compare 7 similar cases reported in the literature and review the risks for development of these aggressive fatal basal cell carcinomas on the scalp. Intracranial invasion by a basal cell carcinoma on the scalp is extremely rare. We present an autopsy case of a 57- year old woman who developed a large destructive basal cell carcinoma with extension through the calvarium and compression of the dura. We compare 7 similar cases reported in the literature and review the risks for development of these aggressive fatal basal cell carcinomas on the scalp.