The multiple, grouped comedones and cysts in the elastotic skin of middle-aged or older patients are designated the Favre-Racouchot syndrome, since the first thorough description of the condition was made by Favre and Racouchot1in 1951. Although the periorbital areas and temples are most commonly affected, the condition occasionally occurs in other sun-exposed areas of the face and neck. Materials and Methods Treatment in the past has not been entirely satisfactory. Simple extraction of the lesions is usually followed by recurrence in the same sites. Dermabrasion produces some improvement but also leaves some changes in the appearance of the skin in the area.2Tretinoin in alcohol solution is stated to be effective, but twice-daily applications during a nine- to 16-week period are required for beneficial treatment results, and some of the openings tend to remain patulous.3,4 Experience with the use of the curette for removal of seborrheic

Complete microscopic control of the excision of carcinomas of the scalp is of special benefit, because, in this location, there is an unusual tendency for outgrowths to extend for considerable distances beyond the clinically apparent borders of the neoplasms. Microscopic control is achieved through layer-by-layer excision of cancerous tissue and the use of frozen sections for systematic microscopic scanning of the undersurface of each layer. The reliability of this technique is demonstrated by the treatment results obtained in a series of 576 basal cell carcinomas. The cure rate for the 444 patients who were observed for five years or longer was 98.9%. In a series of 131 patients with squamous cell carcinomas, the cure rate for the 83 patients who were observed for five years or more was 98.8%. Conservation of maximal amounts of normal tissue is an added benefit of the microscopic control technique.

Chemosurgery is a method of excising cancer of the skin under complete microscopic control. The cancerous area is excised layer by layer after chemical fixation or injection of local anesthetic, and the entire undersurface of each layer is examined under the microscope by the systematic use of frozen sections. The advantages of this method are guarantee of eradication of the cancer and maximal conservation of normal tissue. The operative risk is low and the tissues heal well.

The development of microscopically controlled surgery, the use of the fixed-tissue technique for advanced, complicated carcinomas and for malignant melanomas, the use of the fresh-tissue technique for less advanced carcinomas, the five-year results, and plans for the future of the method are discussed.

Chemosurgery is a method by which cutaneous cancers can be excised under complete microscopic control by the systematic use of frozen sections. The technique consists of three main steps: (1) application of a zinc chloride fixative paste, (2) excision of a layer of fixed tissue, and (3) systematic microscopic scanning of frozen sections cut through the undersurface of the specimens. The procedure is repeated in the cancerous areas until a completely cancer‐free plane is reached. Advantages of the method are unprecedented reliability, conservatism, low operative mortality, excellent healing, and the fact that it extends operability to many patients with cancers too extensive for hope of cure by other methods. Special training is essential for optimal results. Though the method is used by over 50 physicians, more should be trained so that chemosurgery is available in every large population center.

IN THE treatment of epithelioma the "silent" extensions from the main mass of cancer can accurately be followed out and eradicated by means of the multiple, microscopically controlled excisions which characterize the chemosurgical method.1In the treatment of melanoma, however, this microscopic control would seem to be of more limited value because often there is a discontinuous, embolic mode of spread into the peritumoral lymphatics and beyond. The purpose of this article is to attempt to clarify the place of chemosurgery in the treatment of this highly malignant disease through the analysis of a consecutive series of 20 cases of melanoma in patients who have been observed for five or more years or until death. TECHNIC The microscopic control of excision, which is the most important feature of the chemosurgical method, is attained by a process which includes (1) chemical fixation, in situ, of the tissue