We thank Dr Shinder for his comments on our article. We reported that we were not able to achieve negative tumor margins in half of the patients who underwent exenteration because, in those 12 patients, tumor infiltration already had reached the bone. In fact, as mentioned in the text, the computed tomography scan already demonstrated evidence of bone invasion in 8 patients. We consider clear margins to be only those cases having evidence of negative margins on soft tissues of the exenterated orbit, because the evaluation of clear margins on bone is doubtful, particularly if the medial and lacrimal bones and the nasolacrimal duct are involved, because the removal of the bone structure to obtain negative margins in a radical manner could be life threatening, considering the adjacent structures such as the frontal lobe. Sixteen of our exenterated patients had medial canthus and lower eyelid involvement. Eventually, we did not perform a routinely frozen section for the exenteration procedure because the goal of this operation is always to remove the entire orbital content. We use frozen section intraoperative margin control when we deal with a lesion of the superficial periorbital region for which orbital invasion is suspected. In fact, this technique does not allow intraoperative control of the bone. As mentioned in the text, these 12 patients were offered additional therapy, accepted by 7 and consisting of local radiation therapy. Moreover, 4 patients underwent further surgical excision and another 4 underwent additional radiotherapy because of relapse. We are conscious that often the interpretation of data from retrospective research may have some limitations. Nevertheless, we would like to emphasize that the main objective of this study was to evaluate the percentage of patients with basal cell carcinoma who need exenteration and what the possible risk factors are.