concerning adequate treatment and follow-up care for nonmelanoma cutaneous cancer. Specifically, we disagree with the statements that (1) "all primary tumors of the medial canthus be resected by Mohs micrographic surgery" and (2) that in surgical treatment of basal cell carcinomas involving "the eyelids, canthi, pinnae, nasolabial folds, and alae nasi, it is not recommended that a 4-mm margin be utilized, but, rather, that the precise and careful control afforded by Mohs micrographic surgery should be utilized."While we do not dispute the value of Mohs microscopically controlled surgery, especially for the treatment of extensive or otherwise difficult skin cancers, the use of a single technique to the exclusion of all others will not always result in the optimum outcome for an individual patient. Like many of our colleagues, we have treated thousands of basal cell carcinomas of the facial region using the technique of curettage and electrodesiccation.2 While we have not performed a scientific study of our recurrence rate, our global impression is that we have less than a 5% rate of tumor recurrence. It is obvious that tumors in certain locations such as the nasolabial folds, the canthi, and the retroauricular region have a greater chance of recurring.For the elderly, the prospect of more extensive surgery (such as Mohs surgery) is often frightening and debilitating. Many experienced dermatologists will agree that small primary tumors of the canthi, pinnae, eyelids, nasolabial folds, and the retroauricu¬ lar sulcus can often be adequately treated by simple elliptical excision, and, in many early cases, by skillful curettage and electrodesiccation. In experi¬ enced hands, cryosurgery can also offer excellent results.3 Larger tumors often respond very well to radiation therapy, which, when delivered properly, is safe, painless, and affords cure rates almost as high as Mohs micrographie surgery.4 Even for recurrent tumors, Mohs surgery may not always be the treat¬ ment of choice.
