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Background: Perineural invasion of squamous cell carcinoma of the skin causes increased mortality. Objective: We compared survival rates for treatment with Mohs surgery with previous studies of conventional surgery and postoperative radiotherapy. Methods: With a computerized tumor registry we identified 44 cases of squamous cell carcinoma with perineural invasion recurrence, and hazard rates were calculated. Results: Of 44 patients treated with Mohs surgery, three had recurrences. On this basis a survival probability of 88.7% was calculated. Calculation of hazard rate showed highest probability of recurrence 3 to 6 years after Mohs surgery. The clinical characteristics associated with perineural tumor invasion were male sex, size of tumor (>2 cm), forehead location, and previous therapy. Conclusion: When compared with conventional surgical excision and postoperative radiotherapy, early detection and treatment by Mohs surgery of squamous cell carcinoma with perineural invasion result in a much improved survival probability.

Perineural invasion by squamous-cell carcinoma is an ominous sign when discovered by either the pathologist or the chemosurgeon. This report details our experience with seventeen cases of perineural invasion and their successful outcome, using a multidisciplinary approach, including Mohs' surgery.

Eight recurrent basal cell carcinomas and their adjacent scars, which were previously treated with electrodesiccation and curettage, were completely excised by Mohs micrographic surgery and then studied by serial vertical sections. Through the study of an average of 291 serial sections of each recurrent tumor, it was found that four of eight recurrent basal cell carcinomas contained multiple foci of unconnected tumor. It is concluded that iatrogenic multifocality of recurrent basal cell carcinoma previously treated with electrodesiccation and curettage is common. Complete excision of the recurrent basal cell carcinoma and its adjacent scar is supported in view of the high risk of multiple unconnected tumor foci.

A modified method of the fresh-tissue technique of Mohs' surgery is presented with a discussion of its developmental background and advantages. The refinements obviate the need for the chemical fixative. We therefore advocate acceptance of this technique in all cases of cutaneous carcinomas requiring Mohs' surgery.

To the Editor.— Ferguson Smith 1 did not realize that he had discovered an autosomal-dominant trait when he reported a single case of multiple self-healing squamous carcinomas (MSHSC) in 1934. 2 It is now recognized that both familial and sporadic types of MSHSC exist. Both entities are now included in the designation of multiple Ferguson-Smith keratoacanthomas. The MSHSC are occasionally known for an extremely mutilating course and fatal outcome. The patient initially described by Ferguson Smith was again cited 14 years later for extensive nasal destruction that required a prosthesis. 3 Charteris 4 described a patient with MSHSC who died as a result of an extensive recurrent anal lesion. We report a patient with sporadic MSHSC who experienced extensive recurrent perineural invasion of the right supratrochlear nerve. This observation suggests that perineural invasion by keratoacanthoma should not be regarded as an entirely benign condition. Report of a Case.— A 44-year-old

A new entity consisting of multiple, smooth, discrete, macular, off-white, hypopigmented lesions occurring on the upper and lower extremities and scattered areas on the trunk is described. By a random survey, the incidence of this dermatosis was found to be exceedingly high. Histologically, the skin appears normal except for the absence of melanin, and with the B-(3,4-dihydroxyphenyl)-L-alamine (dopa) stain there is decreased to absent dopa oxidase. Through analysis of patient histories, laboratory work, and a review of the literature a hypothesis as to etiology and relationship to other hypopigmenting disorders is discussed.