Introduction Elliptical excisions are the most common method to treat benign and malignant tumors in dermatologic surgery. This standardized design is traditionally 3 to 4.5 times longer than the excisional width to prevent unsightly protrusions of skin after primary closure, known as “standing cone,” “Burow’s triangles” or “dog ear” deformities. This results in a scar significantly longer than the original tumor that may be less easily concealed.
Objective To compare the final repair length of a tissue conservative method to remove skin tumors and close resultant defects against predicted repair length of traditional elliptical excision.
Methods Eighteen cases are presented and retrospectively studied. In these cases, circular excision or Mohs micrographic surgery (MMS) was performed for cutaneous malignancy. After wide undermining and re-evaluation of skin tension lines, a subcuticular suture was placed along the center of the defect parallel to the tension vectors. Standing cone deformities were excised in a standardized fashion so that the final sutured wound would lay flat and a final length was measured. A predicted final length was also estimated using a 3 to 1 ratio of the excision diameter. The sutured repair length was compared to the predicted repair length. Results Surgical sites of the 18 cases consisted of 10 face, 4 upper extremity, 1 lower extremity, and 3 neck. There were 16 repairs after MMS and 2 repairs after circular excision. Malignancies treated included 9 basal cell carcinomas, and 9 squamous cell carcinomas. Post-operative defect sizes ranged from 1.2 cm to 4.2 cm. 18 out of 18 sutured repairs were shorter than the predicted repair length. Standing cone repair resulted in an average 25.96% reduction in predicted repair length.
Conclusion Circular excision of lesions followed by standing cone repair is tissue conservative and complimentary to principles of MMS. This technique should also be highly considered over standard elliptical excision in dermatologic surgery scenarios to improve cosmetic outcomes. Furthermore, future studies should evaluate the effects of tissue dynamics and other clinically relevant geometric measures to optimize the traditional elliptical excision and closure technique.