Time and economic cost of the routine use of marker sutures in surgical management of cutaneous skin malignancies

Dear Editor, Excision and direct closure of cutaneous skin malignancies is a commonly performed surgical procedure. Presentations, and therefore excisions, of cutaneous malignancies including basal cell carcinomas (BCC), squamous cell carcinomas and malignant melanomas continue to increase. In many centres, a ‘marker suture’ is used to orientate a specimen, which may be used to plan re-excision in patients with involved histological margins.

There are flaws with this wisdom. Incomplete margins of high-risk lesions, regardless of location relative to a marker, are often treated with re-excision of the whole scar, with an appropriate radial margin and deep to the next anatomical plane to ensure removal. Incomplete excision of low-risk lesions is not always treated with re-excision. Only 62% of BCC re-excisions contain residual tumour.1 Alternative approaches (observation, topical therapy or targeted radiotherapy) may be used, making marker sutures of little benefit.

Tullett et al. note marker sutures influenced re-excision in only a single case from a series of 663 BCC excisions using marker sutures.2 Other patients with involved margins underwent observation or adjuvant radiotherapy rendering use of a marker suture pointless. Discord exists in the interpretation of marker sutures. Jones et al. note pathologists and surgeons interpret the use and orientation relative to a marker suture differently,3 with risk of inaccurate understanding of a reported involved margin. Risk of misinterpretation is averted with scar re-excision, in which marker sutures are redundant.