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Management of skin cancers without margin control: can it really be an acceptable practice?
  1. A Kadyan,
  2. O M Durrani
  1. Birmingham and Midland Eye Centre, Birmingham, UK
  1. Correspondence to Dr Anju Kadyan, Birmingham and Midland Eye Centre, Dudley Road, Birmingham B18 7QH, UK; anjukadyan{at}btinternet.com

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We read the paper by Chadha and Wright on small margin excision of peri-ocular basal cell carcinoma with interest.1 The authors justify the use of small margins, without margin control (excision and closure without confirmation of histologically clear margins) by their low recurrence rates during a follow-up period ranging from 37–59 months.

There has been extensive debate on the ideal approach to the patient with a suspicious skin lesion. We consider the issues here to be twofold: complete tumour removal and reduced recurrence rate, and these two have been linked in most studies.2 The next dilemma for most of us is to determine factors affecting subclinical tumour extension to achieve a complete removal with minimum excision of healthy tissue. Mohs micrographic surgery is considered the gold standard, as it is shown to achieve …

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