How We Do It: Utility of Conservative Thickness Layers in Mohs Micrographic Surgery in Selected Patients

Second-Intention Healing in Mohs Micrographic Surgery: A Single-Center Academic Experience

“…When a tumor is superficial or exophytic, or when the initial curettage and debulking reveal normal-appearing dermis, the conservative thickness layer (CTL) technique may be beneficial. As described by Tolkachjov and colleagues, 26,27 CTL seeks to maintain MMS layers as thin as possible by positioning the blade almost horizontally (parallel to surface) to score and incise the tumor, instead of at the traditional 45°angle. Regular MMS tumor mapping and margin examination are then followed with additional CTL performed as needed.…”

“…Studies have found that CTL is especially useful in the pretibial surface, convex areas of the nose, scalp, and vermillion lips. [26][27][28] In areas with high sebaceous gland density, such as the distal nose, SIH cosmesis may be optimized by use of the "shave and sand" technique. 29 This technique uses sterile, coarse-grit sandpaper to blend the surgical wound with the surrounding normal skin.…”

“…Further, using CTL expands the well-established tissue-sparing benefits of MMS on margins to include depth as well. Studies have found that CTL is especially useful in the pretibial surface, convex areas of the nose, scalp, and vermillion lips 26–28 …”