A 65 year old male patient was diagnosed with hereditary hemorrhagic telangiectasia at 30. During recent years he has suffered frequent, almost daily, nose bleeds causing anemia and making several blood transfusions necessary. In the past 2-3 years, the patient has developed multiple squamous cell carcinomas on the face. These unusually large tumours were treated by micrographic surgery using paraffin sections and the defects dosed with a variety of flaps and grafts. Several solar keratoses were also removed. If hemostasis parameters are normal, skin surgery can be performed without hesitation in hereditary hemorrhagic telangiectasia.