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Skin Carcinomas: The Isthmus Excision Technique
Two skin carcinomas that are in close proximity can be removed in a single excision. I call this technique the “isthmus excision” (Figures 1, 2, 3, 4, and 5).

In this instance, the isthmus is a narrow anatomical part connecting 2 larger structures. Instead of 1 large excision, in which the widest part of the margin would be under stress, this technique joins 2 elliptical structures with a narrow isthmus of skin. The isthmus is sutured together, creating 2 separate ellipses that now can be closed into 1 linear incision. The result lessens the possibility of incisional dehiscence. Finally, it is important to alert the pathologist that 2 lesions have been incorporated into 1 excision. The specimen should be tagged to facilitate anatomical orientation.