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Maintaining tissue orientation during mohs micrographic surgery: scalpel versus marker
Sepideh Bagheri1, Thomas King, Hildamari Justiniano
1Department of Dermatology, University of California at Davis Medical Center, Sacramento, California, USA. 95816
Background:
Critical to the accuracy of Mohs surgery is the ability to maintain proper orientation of excised tissue with respect to the surrounding skin. Several techniques have been described for maintaining this orientation, although no prior investigations directly compare these techniques.
Objective:
To compare the incidence of tissue orientation loss resulting from inability to identify skin score marks with that occurring from failure to identify marks made using a gentian violet marker during Mohs micrographic surgery (MMS). We also sought to determine the incidence of scars resulting from skin scoring.
Materials And Methods:
Patients undergoing MMS were prospectively randomized to have their tissue margins oriented using light scoring using a scalpel versus marking them using a gentian violet marker. Incidence of scoring scars and tissue orientation loss were the primary outcome measures.
Results:
Data were analyzed for 101 tumors. There were no instances of tissue orientation loss in the scalpel or marker arms, nor were there any visible score mark scars at follow-up.
Conclusion:
Incidence of excessive scars resulting from lightly scored tissue or loss of tissue orientation caused by lost gentian violet markings appears to be low. Both methods worked well within the confines of this study.
Insights
Mohs micrographic surgery (MMS) orientation is crucial. Both scalpel skin scoring and gentian violet marking effectively maintain tissue orientation without significant scarring, ensuring surgical accuracy.
Area of Science:
- Dermatology
- Surgical Pathology
- Oncology
Background:
- Accurate tissue orientation is vital for Mohs micrographic surgery (MMS) success.
- Existing orientation techniques lack direct comparative studies.
- Maintaining the relationship between excised tissue and skin is paramount.
Purpose of the Study:
- Compare tissue orientation loss from skin scoring versus gentian violet marking in MMS.
- Assess scar incidence from skin scoring techniques.
- Evaluate the reliability of orientation methods in Mohs surgery.
Main Methods:
- Prospective randomized study of patients undergoing MMS.
- Tissue margin orientation using either light scalpel scoring or gentian violet marking.
- Primary outcomes: tissue orientation loss and scar formation.
Main Results:
- Analysis of 101 tumors showed no instances of tissue orientation loss.
- No visible scars from skin scoring were observed at follow-up.
- Both scalpel scoring and gentian violet marking proved effective.
Conclusions:
- Low incidence of excessive scarring from light skin scoring.
- Low incidence of tissue orientation loss with gentian violet marking.
- Both methods are effective for maintaining tissue orientation in MMS.
