Analysis of 1,620 basal cell carcinomas treated at the Cleveland Clinic Foundation from 1981 to 1983 confirms that the majority of basal cell carcinomas occur on the face and that the relative risk for recurrent tumor is high in certain locations, especially the nose. Alternately, tumors found on the neck/scalp, trunk, and arms have a low relative risk of recurrence when compared to all other anatomic locations. More primary and fewer recurrent tumors now presenting to our unit have been referred for Mohs surgery as primary therapy. This results in higher cure rates for treatment of all basal cell carcinoma.

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While the majority of patients with basal cell carcinoma are cured by the initial therapeutic approach, high risk patients who have had recurrences of basal cell carcinoma have been identified. From April 1976 to November 1979, 811 patients with 1,271 cutaneous carcinomas were seen at the Mohs' Histographic Surgery Unit of the Cleveland Clinic Foundation. Of these, 496 represented recurrent basal cell carcinomas. Histologic subtype, location of the tumor, and age of the patient were studied in an attempt to identify factors which place patients at risk for persistent or recurrent carcinoma. The physician who first sees a patient with basal cell carcinoma should look for these risk factors and, after identifying such patients, consider an aggressive management with frequent follow‐up.

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Superpulsed carbon dioxide lasers emit a controlled train of short duration, high-power pulses which minimize the protein coagulation effects of the laser. Very high irradiances can be used with superb control of vaporization without significant peripheral heating. In incisional work, superpulsing permits the surgeon to advance the hand piece as slowly and as accurately as desired, while experiencing a fraction of the necrosis attendant to conventional continuous-wave lasers. In vaporizational applications, target tissue volumes are flash vaporized before significant heat can be transferred to surrounding tissue, promoting faster wound healing and reduced scarring. The superpulse feature may significantly change the way in which the carbon dioxide laser is used in cutaneous surgery.