Background: The elliptical (fusiform) excision is a basic tool of cutaneous surgery. Objective: To assess the design, functionality, ease of construction, and aesthetic outcomes of the ellipse. Design: A systematic review of elliptical designs and their site-specific benefits and limitations. In particular, we consider the (1) context of prevailing relaxed skin tension lines and tissue laxity; and (2) removal of the smallest possible amount of tissue around the lesion and in the "dog-ears." Attention is focused on intuitive methods that can be reproducibly planned and executed. Results: Elliptical variations are easily designed and can be adapted to many situations. The eccentric parallelogram excision is offered as a new technique that minimizes notching and focal tension in the center of an elliptical closure. Conclusion: The elliptical (fusiform) excision is an efficient, elegant, and versatile technique that will remain a mainstay of the cutaneous surgical armamentarium.
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