The 5-year risk for a patient with one previous skin cancer developing another skin cancer is 27%, which increases to 49% with a history of 2 previous skin cancers. The risk, when there have been more than 4 previous lesions, is greater than 73%. In our series, all patients had a history of long-term sun exposure. Four of the 5 patients with positive subunits were male, and 4 patients had recurrent BCC. Two of the 5 patients had multiple tumors at presentation. We did not have data on the total number of previous skin cancers or documented information on the patients' skin types; however, because many of the patients had multiple tumors, one can assume that many of these patients were fair complected. When this study was initiated, we had no inkling as to what its outcome might be. Based on our data, one might conclude that in our patient population a higher-than-expected recurrence rate could be anticipated after MMS; yet this has not been our experience. Repeated review of our long-term statistics has shown 5-year cure rates of 98% or more. The patients in our study had surgical defects of significant size, but other than that, there was no bias in their selection for referral for reconstruction or for their inclusion in this study. However, in all likelihood, there probably was some bias regarding their referral for Mohs surgery; ie, often, the more difficult cases are referred for Mohs surgery. Therefore, many of the patients in our study, especially those with tumor in their cosmetic units, may not typify most patients with skin cancers of the head and neck, but would be better classified as "high-risk" patients. Thus, for the "average" or "low-risk" patients (ie, those with a single primary tumors and without a history of skin cancer), it may not be necessary to routinely submit cosmetic subunits removed at the time of reconstruction for pathologic examination. However, based on our experience, we suggest that in patients with recurrent tumors (ie, high-risk patients) or a history of multiple skin cancers and significant actinic damage the donor site be closely scrutinized for tumor lest it be transferred into a tumor-free wound and that the excised subunit(s) be submitted for pathologic examination.