Mohs Micrographic Surgery as Only Means of Optimal Patient Outcome

To the Editor.— We would like to comment on the editorial by Dr June K. Robinson 1 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