Both diagnostic and therapeutic problems remain in the treatment of basal cell carcinomas of the eyelid. Incorrect initial diagnosis and resulting inadequate treatment can lead to the loss of the bulbus. Inadequate follow up may result in failure to detect a recurrent tumor. We retrospectively studied 226 patients with basal cell carcinoma of the eyelid who had surgery some time between 1980 and 1989. In 179 patients, a primary lid tumor was removed; the recurrence rate for these patients was 6.1%. Forty-seven patients had surgery for secondary eyelid basaliomas; the recurrence rate for these patients was 14.8%. These recurrence rates correlated clearly with the horizontal extent and depth of the tumor, and with the appearance of the sclerodermiform type. The fact that recurrences were found after 3 years demonstrates the importance of long-term follow up in these patients, especially in those with secondary tumors and tumors of exceptional height.