A comprehensive preoperative decision-making tool for optimal surgical closure: CHAIRS
Charles Ayesa1, Jeremy Hay2, Clara Jimenez Balcells3
1MBBS (Hons), BMedSci, FRACGP, FSCCA, College Censor, Skin Cancer College Australasia, Brisbane, Qld; Clinical Senior Lecturer, University of Queensland, Faculty of Health Sciences Primary Care Unit, Brisbane, Qld; Honorary Senior Lecturer, Macquarie University MQ Health, Sydney, NSW; General Practitioner, SkinSense Clinic, Sydney, NSW; General Practitioner, Icon Cancer Centre, Sydney, NSW.
Australian Journal of General Practice
|August 6, 2026
Summary
CHAIRS is a new mnemonic for skin cancer surgery planning. It helps doctors prioritize cancer cure, function, complications, and cosmesis for better surgical outcomes.
Area of Science:
- Dermatology
- Surgical Oncology
- Plastic Surgery
Background:
- Skin cancer excision and repair can be complex, particularly in the head and neck or with intricate closures.
- Optimizing decision-making requires explicit consideration and ranking of competing factors during the planning stage.
- The four hierarchical surgical goals are: cancer cure, avoiding functional disturbance, avoiding complications, and achieving good cosmesis.
Purpose of the Study:
- To design a memorable, formal process to aid doctors in considering and ranking surgical variables for skin cancer treatment planning.
- To develop an acronym that ensures the hierarchy of surgical importance is established before proceeding to the solution phase.
Main Methods:
- The development of the 'CHAIRS' mnemonic, representing Cure the Cancer; Hole; Area/Alignment; Icebergs/Incidents; Reservoirs; Solution(s)/Salvage.
- Implementing a structured approach to preoperative planning in skin cancer surgery.
Main Results:
- The CHAIRS mnemonic provides a framework for structured and orderly preoperative planning.
- It assists in ensuring all relevant variables are considered and ranked according to surgical importance.
Conclusions:
- CHAIRS facilitates favorable outcomes in skin cancer surgery through systematic preoperative planning.
- The mnemonic serves as a valuable learning tool for less experienced surgeons and a foundational reminder for experienced practitioners.
- CHAIRS is easily learned, remembered, and taught, promoting consistent application of best practices.
