Sergio Schrader Serpa1; Felipe Maurício Soeiro Sampaio2; Felipe Bochnia Cerci3, 4, 5, 6
Financial support: None
Conflict of interest: None
How to cite this article: Serpa SS, Sampaio FMS, Cerci FB. Barrier spray to prevent surgical marking erasure in Mohs micrographic surgery. Surg Cosmet Dermatol. 2023;15:e20230209.
The preservation of the surgical margins marking is essential during Mohs micrographic surgery. However, skin degermation during antisepsis and the use of gauze during local anesthesia often remove these markings. The use of the protective film Cavilon® 3M to fix the marking pen ink was effective in preserving the surgical map, allowing an accurate removal of the surgical specimen.
Keywords: Mohs surgery; Carcinoma, Basal cell; Carcinoma, Squamous cell; Excision Margins
Precise visualization of the surgical margins and of the Mohs map is essential during Mohs micrographic surgery (MMS).1 However, the use of antiseptic solutions during degermation and gauze to dry any drops of blood during local anesthesia promote the partial or complete removal of these markings.2 To fix the surgical skin marker ink and prevent this erasure of the surgical map, we describe the use of Cavilon® 3M barrier film spray.
Before drawing the surgical map, perform a “pre-degermation” using chlorhexidine, alcoholic or aqueous, or 70% alcohol, and remove the product with dry gauze. Then, with the surgical skin marker, demarcate the tumor and mark the surgical site based on clinical and dermoscopic criteria. Next, apply the Cavilon® 3M barrier film spray and let it dry for about 30 seconds. Usually, we spray the product three times over the marker ink to ensure it has reached the entire area. The patient’s eyes and mouth must be protected. When the surgical site marking is close to these regions, fix the product by direct contact with gauze or using the tip of a cotton swab dipped in the barrier film. After the product dries, perform additional antisepsis and other surgical steps in the usual way.
We randomly selected ten patients with basal cell carcinoma (BCC) on the face to undergo MMS and the application of a barrier film over the surgical site marking. In eight cases, the markings were maintained after antisepsis, local anesthesia, and tumor removal (Figure 1). In one case, the ink was barely visible after tumor debulking, and, in another case, the markings disappeared completely after antisepsis. We noted that for proper ink fixation, cleaning the skin surface and complete chlorhexidine removal must be carefully performed. The amount of ink and barrier film applied to the skin surface is also a possible influencer. We did not observe contact dermatitis or bacterial infection in any patient.
Precision is one of the cornerstones of MMS, and proper visualization of the surgical site marking is crucial. Impaired visualization of surgical margins can lead to unnecessary removal of healthy skin, which, even if small, significantly increases the diameter of the wound, as the area of a circumference is calculated by the formula π x r2 (the radius corresponds to the surgical margin).3 Furthemore, impaired visualization of the surgical margins can lead to incomplete tumor removal, generating additional surgical stages and extending the surgery, increasing patient anxiety and procedure costs. As we know, remarking surgical margins does not always maintain the same precision because, after local anesthesia, the visualization of tumor borders becomes challenging.
Cavilon® 3M is traditionally indicated for skin protection related to the irritating action of fluids from urinary and/or fecal incontinence, digestive juices, effluents, wound exudate, use of adhesives, and friction. The product acts as a non-alcoholic, spray-on, clear liquid barrier that dries quickly and forms an airy protective layer that helps protect intact or damaged skin from body fluids (incontinent patients), medical adhesives, and friction.4 In addition to its traditional use, Cavilon® 3M can prevent erasure of surgical markings. In plastic surgery, Gupta et al. demonstrated the use of the product for planning the reconstruction.5 In orthopedics, it was described as a tool to maintain surgical markings after removing povidone-iodine adhesive tapes.6
The use of Cavilon® 3M barrier film spray helps maintain the Mohs surgery map on the patient’s skin, making tumor removal more accurate.
Sergio Schrader Serpa 0000-0002-5805-4154
Approval of the final version of the manuscript; study design and planning; preparation and writing of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases.
Felipe Maurício Soeiro Sampaio 0000-0002-2235-5473
Approval of the final version of the manuscript; study design and planning; preparation and writing of the manuscript; data collection, analysis, and interpretation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical literature review; critical revision of the manuscript.
Felipe Bochnia Cerci 0000-0001-9605-0798
Approval of the final version of the manuscript; study design and planning; preparation and writing of the manuscript; data collection, analysis, and interpretation; critical literature review; critical revision of the manuscript.
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3. Cerci FB, Kubo EM, Werner B, Tolkachjov SN. Surgical margins required for basal cell carcinomas treated with Mohs micrographic surgery according to tumor features. J Am Acad Dermatol. 2020;83(2):493-500.
4. 3M. Ciência. Aplicada à vida. 2023. [Cited 2022 Dec 19]. Available from: https://www.3m.com.br/3M/pt_BR/p/d/v000495439/
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