Purpose: To analyze the outcome of management of patients with basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) in a tertiary referral eye center in Sydney, Australia. Design: Retrospective case series. Methods: Review of medical records of 485 consecutive cases (469 patients) with confirmed eyelid cancer. intervention procedures: Surgical excision with 3- to 5-mm clinically clear margins and histologic confirmation of the surgical margins. Frozen section histology or Mohs' micrographic surgery (MMS) was used for incompletely excised cases, and those located in the medial canthus or close to the lacrimal drainage system. Standard reconstruction techniques were employed. main outcome measures: Survival period free of tumor, incomplete excision, recurrences, type of closure, and complications. Results: Excision was initially incomplete in 25.4% of all tumors. Morpheaform type of BCC (χ2 P < .001), and medial canthus location BCCs (χ2 P < .05) were associated with a higher incomplete resection rate. A 35.9% incomplete excision rate was associated with a significantly higher recurrence rate compared with complete excision (8.4% and 4.6%, respectively, χ2 P < .05). Twenty-seven patients (5.6%) had a recurrent tumor. After incomplete excision, there was no recurrence with MMS, but 4.7% recurrence rate when frozen section technique was used (P < .05). Local postoperative complications occurred in 41 patients (8.5%). Conclusions: In the setting of a tertiary referral center, incomplete primary resection of an eyelid skin cancer is the main risk factor for recurrence. Incomplete resection is significantly associated with medial canthus location and morpheaform type of BCC and with moderately differentiated SCC. MMS is the safer technique after incomplete tumor excision.