The concept for surgical removal of facial skin neoplasms consists of three components: Sufficient preoperative clinical diagnosis; complete tumor removal; Adequate functional and esthetic reconstruction. For achieving proper diagnosis the collaboration with the dermatologist is highly recommended. The ENT examining microscope allows for better visualisation of structural characteristics. Excisional biopsy should be preferred whenever possible. Out of 97 basal cell carcinomas 25% secondary or thirdly neoplasms have been found. In 81 basal cell carcinomas the visible extent, the real tumor extent in the specimen after fixation and the total excisional area are compared. According to these measurements the following safety margins seem to be recommendable: For small solid or solid-cystic superficial basal cell carcinomas 3-5 mm, for the sclerodermiform or partially undifferentiated basal cell carcinoma 10-20 mm and for basal cell carcinomas involving the bone more than 20 mm. Excising a spinocellular carcinoma a safety margin of at least half of the maximal diameter has proved to be sufficient. The close collaboration with the histopathologist resulted in our department in a simplified economic and safe microscopically controlled excision. The rate of recurrences of 97 basal cell carcinomas was 6.6%. The question of prophylactic lymph-node dissection in combination with the excision of spinocellular carcinomas is discussed.