Objective Basal cell carcinoma (BCC) is a common tumor all over the world that affects middle age and elderly people that often involve the face and scalp in people with skin type I although other skin types are inflected. Sun-damaged skin is more liable to have this disease. The objective of the study is to evaluate the different demographic and clinical pictures in a series of 140 patients with basal cell carcinoma in relation to solar keratosis and wrinkling. Methods This is a case series descriptive study where all patients with BCC were recorded during the period from 2014-2022. All demographic features were described and a full clinical examination was carried out. Skin photo type was established for all patients according to Fitzpatrick's classification. The sites, the number of lesions, the type of lesions, the associated solar keratosis, and squamous cell carcinoma were evaluated. A histopathological examination was performed as a confirmatory test. Results This study included 140 patients, whose ages ranged from 35-75 years with a mean of 60 years, with 95 (67.9 %) males and 45 (32.1%) females. All patients who had outdoor activities with Fitzpatrick's classification of skin type were type III and IV. The location of lesions was 117 (83.6%) on the face and scalp while in 23 (16.4%) patients, the lesions were located on the covered parts body mainly the trunk and limbs. The tumor was pigmented in 123 (87.9%) cases while in 17 (12.1%) patients lesions were non-pigmented. The associated solar keratosis was observed in 20 (14.3%) cases but no case with squamous cell carcinoma was detected. The number of lesions was multiple in 42(30%) cases while single lesions were in 98 (70%) cases. Coarse wrinkling of the face mainly the forehead and around the eyes was detected in 20 (14.3%) cases. The type of lesions were ulcerative superficial non-healing ulcers while few cases presented with nodular lesions but rarely with rolled-up rodent ulcers. Also, a few cases are presented with thread-like margins. Conclusion Pigmented basal cell carcinoma is a common disease seen in older male patients with skin type III and IV living in highly sunny atmospheres presenting with a single pigmented superficial non-healing ulcer in non-wrinkling skin with low association with solar keratosis but no cases with squamous cell carcinoma. Accordingly, BCC develops and appears de novo without preexisting solar keratosis.