Granular cell basal cell carcinoma is an unusual histopathologic subtype of basal cell carcinoma in which some or all of the neoplastic cells show cytologic features of granular cells. These distinctive cells contain abundant eosinophilic cytoplasm housing numerous fine and coarse refractile granules. This report documents the first case of granular cell basal cell carcinoma in which the collections of neoplastic granular cells arise in direct contiguity with an otherwise ordinary nodular basal cell carcinoma. Granular cell basal cell carcinoma is a unique histopathologic variant of basal cell carcinoma that is rare, this report representing the sixth case in the world literature.