We report 7 cases of microcystic adnexal carcinoma (MAC) that involved the face (n=6) and neck. The neck case occurred in a 10-year-old boy. MAC are tumors that typically extend far beyond their assessed clinical margins. This report emphasizes the need for early microscopically controlled excision of lesions because of the unreliability of clinical assessment and frequent perineural and bone extension. Treatment results of 35 cases treated by Mohs surgery are tabulated.