When basal cell carcinoma develops cystic change, its clinical and radiological features vary, leading to confusion in differential diagnosis. We report four cases with cystic formation of 62 patients with orbital and adnexal basal cell carcinoma encountered during the last 12 years. The salient clinical, radiological, and histopathological features of these cases are presented and differential diagnosis of large cystic lesions in the orbit is discussed. When the basal cell carcinoma develops cystic changes it mimics other orbital cysts, including inclusion cysts due to penetrating injury, mucoceles, and necrotic metastatic tumors.