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Elliptical excision planning — SCE Dermatology MCQ

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HardSkin surgery and cosmetic dermatologyElliptical excision planningSCE Dermatology

A benign symptomatic intradermal naevus on the cheek is being removed by elliptical excision. Which orientation principle best reduces closure tension and conspicuous scarring?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Align the ellipse with relaxed skin-tension lines

The best answer is “Align the ellipse with relaxed skin-tension lines”. NICE bases melanoma diagnosis, excision margins and nodal assessment on complete histology, Breslow thickness, ulceration and clinical stage, with specialist review of suspicious or changing lesions. The alternatives “Place the long axis perpendicular to tension lines”, “Use a circular punch larger than the lesion”, “Close under maximal tension to flatten the scar”, “Avoid histology because the lesion looks benign” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE NG14 melanoma recommendations: https://www.nice.org.uk/guidance/ng14/chapter/Recommendations