Objective To retrospectively analyze the relevant data of patients with cutaneous basal cell carcinoma (BCC), and understand the epidemiological characteristics, surgical features and misdiagnosis of BCC in Sichuan region.Methods The information of patients clinically diagnosed or pathologically diagnosed as BCC in the inpatient Department of Dermatology of Sichuan Provincial People's Hospital from October 1, 2018 to November 1, 2023, and were collected and analyzed. Results The postoperative pathological diagnosis of BCC was found in 131 patients. The male-to-female ratio was 0.68 to 1. The median age was 68 years old. 92.5% of the patients had skin lesions in exposed areas, 8% of the patients had recurrence, and only one patient had a family history of BCC. Patients with a length of hospital stay > 1 day were older and more likely to have skin lesions > 5 cm2 or even > 10 cm2 (P< 0.05). There were differences in the size of the lesion, the method of lesion repair, and the positive rate of intraoperative freezing in the first operation at different lesion sites (P < 05). All patients underwent surgical treatment during hospitalization. The median operation time was 75 minutes, and the median average distance from the resection margin to the tumor edge was 4 mm. 16.8% of patients had positive frozen resection margins for the first time during the operation, and age was an influencing factor (P < 0 times 05). The preoperative clinical diagnoses of 18 patients did not match the postoperative pathological diagnoses. Among them, the non-BCC diagnoses included 2 cases of pigmented nevus, 7 cases of squamous cell carcinoma, 1 case of atypical squamous epithelial hyperplasia, 4 cases of skin tumors (not further classified), and 4 cases of basal squamous cell carcinoma. The diagnostic accuracy of BCC in the preoperative complete biopsy group was higher than that in the incomplete biopsy group (P <0.05). ConclusionIn Sichuan region, the skin lesions of inpatients with BCC who undergo surgical treatment tend to occur in exposed areas, mostly in the elderly, and usually have no family history. The operation time and hospital stay are usually short, and the length of hospital stay is related to the size of the skin lesion and age. The location of the disease and age affect the positive rate of the first frozen incision margin. BCC is often confused with pigmented nevus, squamous cell carcinoma, atypical squamous epithelial hyperplasia and basal squamous cell carcinoma in clinical practice. Preoperative biopsy remains the most commonly used diagnostic method that can effectively improve the accuracy of diagnosis