The development of the circle technique for determining the optimum line of tumour excision

The healing of skin wounds is markedly influenced by their relationship to the tensional forces in the skin. Directional variations in skin extensibility which give rise to the cleavage line phenomenon and the skin tension lines are easily visualized by a recently developed skin marking technique. This technique makes it possible to plan accurately the optimum line of excision of skin tumours, including malignant melanomata, so as to allow primary linear wound closure without the necessity of undermining or grafting. The technique is particularly applicable to the excision of tumours of the back and limbs, and in addition, provides a warning if the local skin tensional state makes primary closure hazardous.