The patient we describe had eyelid lesions exhibiting an erythematous, hyperkeratotic component and an excoriated area within these erythematous areas. The lesions obviously involved the skin, not the underlying tissues or the lid margins. Two therapeutic options were considered for this patient. One was to perform a biopsy of the lesions and to perform definitive surgery, if needed, at a later date. Disadvantages of this option were the possible need for additional surgery, the inconvenience to the patient of an additional procedure, and the issue of sampling error given the variability of appearance in different areas of the lesion. The other option was to perform an excisional biopsy and submit the total specimen. After discussing these options, the surgeon and the patient agreed on excisional biopsy. The lesions were completely excised, and the surgical sites were closed easily with local skin flaps. Had a need for major, full-thickness reconstruction of the lids after excision been anticipated, preliminary biopsy would have been preferable. However, this was not the case in this patient. Careful planning spared him additional surgery, permitted acquisition of ample tissue for definitive diagnosis, and left no question about sampling error.