Background: High-frequency ultrasound imaging is increasingly used as a noninvasive, accurate, and real‐time method to evaluate non-melanoma skin cancers (NMSC). It plays a complementary role in the physical examination and the detection margins of skin cancers. Objectives: This study investigates the efficacy and accuracy of high-frequency ultrasound as a complementary method to ensure complete elimination of skin cancers with maximum preservation of function and aesthetics, with postoperative confirmation based on histopathological examination. Patients and Methods: This was a cross-sectional study. Forty-nine skin lesions in forty-seven patients underwent preoperative ultrasound examination using (6-19 MHz) probes. Ultrasound examination included lesion nature, thickness, invasion depths, and the subsequent excision size of the lesion circumferentially and in-depth. Results: Forty patients had forty–two lesions. Ultrasound had the ability to differentiate skin cancers from fibrosis and to detect subclinical lesions extensions with better clearance of malignancy. Conclusion: High-frequency ultrasound can provide additional information for preoperative evaluation of non-melanoma skin cancers with maximum preservation of function and aesthetics in addition to be a valuable non radiating tool for postoperative follow up for NMSC after surgical excisions to determine the presences or absence of early recurrence before skin ulceration.