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Mnemonics, Simplified Concepts & Thoughts

Geometry and Margins of Elliptical Excision

Epomedicine, Aug 10, 2024Aug 10, 2024

Last updated on August 10, 2024

Ends of ellipse (Apical angles):

  • 30-degree angle (to minimize potential dog-ears or standing cones)
  • Slightly larger angles possible in looser skin

Dimension of ellipse:

  • Length to Width ratio of 3:1
  • Greater than 3:1 ratio may be desirable in tighter skin, skin over the joints, and curved surfaces

Axis of ellipse:

  • Along the wrinkle line or relaxed skin tension line
elliptical excision

Margin of excision:

Lesion typeSurgical margin
UncertainConsider shave or punch biopsy to delineate prior to elliptical excision or start with 1- to 2-mm margins to avoid unnecessary tissue removal.
BenignVisible lesion removed
BCC3–5 mm
SCC3–6 mm
Initial excision of possible melanoma1–3 mm
Melanoma in situ5 mm
Melanoma < 1 mm10 mm (may need referral for lymph nodes 0.75 to 1 mm depending on ulceration, regression, or mitotic figures)
Melanoma > 1 mm20 mm and lymph node evaluation
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Epomedicine. Geometry and Margins of Elliptical Excision [Internet]. Epomedicine; 2024 Aug 10 [cited 2025 May 31]. Available from: https://epomedicine.com/surgical-skills/geometry-and-margins-of-elliptical-excision/.

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