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Our objective was to quantify the skin wasted during elliptical excision biopsy. This is defined as the difference between the excised elliptical area and the area of the original lesion. We used geometrical calculations of 26 excisional biopsy specimens from patients with non-melanomatous malignant tumours. Relative to the lesion area, the largest waste of skin measured was 230% and the smallest was 34% with a mean of 130%. We conclude that for better preservation of tissue when closing circular defects, patterns other than an ellipse should be adopted.

The common excision skin pattern is either a fusiform ellipse or another pattern with dissimilar length and width. The purpose of this study was to define the most advantageous skin pattern regarding skin waste, vertex angle, and scar length. Five skin excision patterns used traditionally for closure of round lesions were analyzed: fusiform ellipse, fusiform circle, rhomboid, mosque, and S-shaped. In the analysis, the pattern characteristics were formulated by geometric principles, from which the results were compared. The smallest skin waste was found in rhomboid and mosque patterns, whereas the largest skin waste was found in the fusiform circle and ellipse. The vertex angle was found to decrease monotonously with the excision length-to-width ratio for all patterns except the mosque shape, which is zero per definition. The paradigm stating that a vertex angle of 30 degrees or less is maintained for length-to-width ratios below 4 in the surgical ellipse was found incorrect. It holds only for rhomboid and S-shaped excisions. The scar length was found almost independent of the pattern, with a variance of 3 percent. The authors conclude that the most advantageous surgical skin patterns are the rhomboid and mosque excisions.