Electrochemotherapy has been demonstrated to be an effective and well-tolerated therapy for solid tumors in both experimental and clinical studies.12,13 In several clinical trials, ECT with bleomycin gave the best response rates in BCC among a variety of primary and secondary skin tumors,8- 10,12 with a complete response in up to 94.4% of cases after 1 treatment session.8 We then decided to use ECT with bleomycin in our patient as a palliative treatment to reduce the tumor burden and patient's discomfort. After the first favorable results with intralesional bleomycin, we moved to intravenous administration to treat more lesions per session. In the choice between intralesional and intravenous administration, one should consider both the possible differences in drug delivery to the tumor (eg, in cases of impaired circulation) and practical therapeutic and technical issues (eg, number of nodules to be treated, dose-related adverse and toxic effects, timing between drug administration, and electroporation). Both modalities of ECT in our case proved successful in the local control of BCC skin metastases in clinical conditions (ie, number, dissemination and closeness of lesions, severe lymphedema of the limb), whereas other approaches, such as surgery or radiotherapy, would have been unsuitable and hazardous due to the high risk of ulceration, bleeding, infection, and delayed healing. A complete healing by secondary intention was observed within 3 months, with minimal adverse effects. The therapeutic response occurred without any increased morbidity for the patient in tissue-sparing and low-risk conditions due to the minimal doses of bleomycin, local anesthesia, and absence of surgical wounds. Our case represents, to our knowledge, the first to test the potential role of ECT as palliative therapy in metastatic BCC. Electrochemotherapy allowed for the rapid treatment of multiple lesions, greatly reducing the risks, downtime, and adverse effects linked to surgery, radiotherapy, and systemic chemotherapy.