From the Guidelines
Thigh Mole Excision Orientation
The excision of a thigh mole should be oriented vertically, as this aligns with the natural skin tension lines, also known as Langer's lines, which run longitudinally on the thigh 1, 2.
- This orientation helps to minimize the risk of wide scars and promotes better wound healing and cosmetic outcomes.
- A 1-2 mm margin of normal skin around the mole is typically recommended, and the excision should be done using a sharp scalpel or surgical scissors 2.
- The axis of excision should be orientated to facilitate possible subsequent wide local excision; generally on the limb this will be along the long axis 2.
- Key considerations for the excision include: + The entire tumor should be removed with a clinical margin of 2 mm of normal skin, and a cuff of fat 2. + The excision biopsy should allow confirmation of the diagnosis by examination of the entire lesion, such that subsequent definitive treatment can be based on Breslow thickness 2.
- Post-operative care may include applying topical antibiotic ointment and covering the wound with a sterile dressing for 24-48 hours, with follow-up evaluation in 7-10 days for suture removal, if necessary.
From the Research
Thigh Mole Excision Orientation
When considering the orientation of a thigh mole excision, several factors come into play, including the natural tension lines of the skin and the aesthetics of the resulting scar.
- The study 3 found that the main direction of natural skin tension on the thigh is between 0°-20°, considering the longitudinal axis of the body as 90° and the transversal axis as 0°.
- Another study 4 described the circumferential thigh lift and vertical extension circumferential thigh lift, suggesting that when soft-tissue excess is limited to the proximal third of the thigh, a horizontal excision pattern is used, while a vertical extension is employed for middle and lower one-third thigh excess.
- The concept of biodynamic excisional skin tension lines is discussed in the study 5, which found that on the limbs, a vertical orientation of ellipses results in the least wound tension.
- A similar finding is reported in the study 6, which investigated biodynamic excisional skin tension lines on the lower limb and found that vertical closure resulted in a statistically significant reduction in closing tension compared to other directions.
- The study 7 emphasizes the importance of incision orientation in dermatologic surgery, highlighting the need to consider anatomical, clinical, and histological factors to achieve optimal aesthetic and functional results.
Implications for Thigh Mole Excision
Based on the available evidence, it appears that a vertical orientation for thigh mole excision may be preferable in terms of minimizing wound tension and optimizing aesthetic results.
- The study 5 suggests that vertical orientation of ellipses on the limbs results in the least wound tension, which is supported by the findings of the study 6.
- However, the study 4 suggests that a horizontal excision pattern may be used for soft-tissue excess limited to the proximal third of the thigh, highlighting the need for individualized consideration of each case.
- The natural tension lines of the skin, as described in the study 3, should also be taken into account when planning the orientation of the excision.