The advantages of direct defect closure over skin grafting or flaps are both obvious and well documented. There is no additional scarring, no donor site, and as only local skin is used, the tissue match is perfect. We read with interest the recent article by Peden et al. who studied patients with small margin (≤2 mm) excision of clinically well-demarcated primary periocular BCCs in the non-Mohs setting of one-stop clinic, achieving 87% rate of one-stage excision and direct closure, while 13% had excision with delayed reconstruction [1].

Transformation of a defect’s geometry is possible because of the inherent mobility of the face. One can demonstrate this for oneself by placing a finger on one’s cheek bone noting that the skin can be moved in all directions by two or more centimetres. Consequently, there is absolutely no need for undermining, a practice that creates more scar planes.

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