Abstract Objective To present the results of all patients with periocular squamous cell carcinoma (SCC) treated with Mohs' micrographic surgery (MMS) in Australia between 1993 and 1999. Design Prospective, noncomparative, multicenter, interventional case series. Participants Seventy-nine patients undergoing MMS for periocular SCC over a 7-year period (1993–1999). Main outcome measures Recurrence after MMS, site, size, prior recurrence, defect size, histologic subtype, and presence of perineural invasion (PNI). Results Seventy-nine patients had 54 (68%) lower eyelid, 19 (24%) medial canthus, and 6 (7.6%) upper eyelid SCCs. The most common histologic subtypes were well differentiated (48.7%) and moderately differentiated (35.1%) SCC. Seventy-three percent were primary tumors and 27% were recurrent tumors. Three (4.3%) cases had histologically confirmed PNI. Two of the 3 cases with PNI were recurrent ( P = 0.1355), and surgical excision was the most frequent prior treatment ( P = 0.0192), with up to 3 prior excisions in 1 case. None of the patients with PNI received adjunctive radiotherapy, and none have recurred with follow-ups to date of 4, 5, and 6 years, respectively. A median follow-up of 73 months (mean, 77.3; range, 42–117) was available in 56 (71%) cases, of which 2 (3.64%; exact 95% confidence interval, 0.44%–12.53%) recurred. Both cases were primary, moderately differentiated SCCs. Conclusion This is the largest reported prospective series of periocular SCC managed by MMS, with a median follow-up of over 5 years. It demonstrates that MMS has the lowest reported recurrence rate (3.64%) of any treatment modality for periocular SCC. That there were no recurrences for cases with PNI further emphasizes the importance of margin-controlled excision for periocular SCC.