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Le tt er For patients with a low risk for squamous cell carcinoma (SCC), the National Comprehensive Cancer Network (NCCN) guidelines (version 1.0, 2020) recommend excising the area with a 4to 6-mm margin; however, decisions for high-risk cases should be based on the clinical characteristics of the tumor and the patient’s condition. Similarly, the NCCN guidelines for cutaneous melanoma state that “margins may be modified to accommodate individual anatomic or functional consideration and consider histologic margin assessment prior to reconstruction and closure” [1]. Extensive subclinical spreading was found in 14% to 15% of primary SCCs and 23% to 50% of recurrent SCCs. In addition, patients who undergo Mohs microsurgery and have recurrent tumors have a higher risk of recurrence than those treated with wide excision [2]. The probability of spreading is high in cases of recurrent cancer, so freely achieving the maximum possible margin with subsequent aesthetic reconstruction may be the most effective approach for treating skin cancer. When recurrence takes place due to insufficient margins at the time of primary resection, it is important to consider the patient’s discomfort resulting from periodic visits due to positive results along the resection margin, the costs of reoperation and diagnosis, and the invasiveness of the procedure. The least amount of secondary wound contraction occurs with LETTER

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Response to Letter: A retrospective 10-year review of cutaneous squamous cell carcinomas of the hand and adherence to British Association of Dermatologists guidelines