The aim of this study was to analyze the scope of pre-surgical high resolution ultrasound in basal cell carcinoma (BCC). BCC is the most common human cancer. According to recent large prospective studies incomplete excision of BCC is higher than expected. Pre-operative imaging may aid surgical planning by identifying the extent and location of a neoplasm, which can be interesting at zones with higher risk of recurrences such as the face. These are slow growing tumors but there are some aggressive types described that can involve deeper structures. Twenty-five patients were studied (10 F/15 M, 48-91 years old; mean age 69.5 ± 11.5 years) with suspicious facial lesions ≤1.5 cm. Pre-surgical ultrasound with compact linear 15-7 MHz probe was performed. Ultrasound reported the morphology and thickness of the tumors. The results were correlated with the histology. Ultrasound identified 29 suspicious facial lesions that were removed with tumor-free borders at the first surgery and confirmed by histology. The main location was the nose. Two subclinical satellite lesions at the nasal zone were detected under ultrasound which led to a change in the surgery plan. The intraclass correlation coefficient (ICC) value was used to compare tumor thickness measurements between ultrasound and histology. ICC was considered as very good (0.9). Therefore, ultrasound can be useful to plan BCC surgery, it can recognize lesions, layers of involvement and vascularity patterns in a non-invasive way. It can show subclinical satellite lesions, even though the number of subclinical cases is small and require further investigations. It has a good thickness correlation with histology and may be used as a technique to monitor disease changes following non-invasive medical treatments in the future.