An 82-year-old white man presented with a 2- to 3-month history of a lesion in his left medial canthal region. Surgical excision of the lesion was performed, and histopathology showed a nodular basal cell carcinoma of the caruncle. Because of incomplete surgical margins after the initial excision, a second excision was performed, followed by a course of adjuvant radiotherapy. No tumor recurrence was detected in the caruncle after 6 months of follow-up.