Treatment options for periocular MAC include wide local excision, Mohs micrographic surgery, and radiotherapy. Perhaps reflecting the infiltrative nature of MAC, small series using Mohs surgery have shown a lower recurrence rate (0%-12%) as compared with en bloc excision (30%-47%).5 Toluidine blue staining during Mohs clearance helps highlight tumor strands and perineural invasion. Exenteration is advised for perineural or orbital infiltration, and palliative or adjunctive high-dose radiotherapy may be used. Despite its invasive nature, periocular MAC has a fairly good prognosis, with only 7 cases of metastasis and 1 death reported. Intracranial invasion has been reported, and its presence in 2 of our patients must limit their chance of cure (cases 1 and 2).