The fusiform ellipse is a fundamental excisional technique in cutaneous surgery. Mastering this technique along with its variations lays the groundwork for the successful development of more complicated techniques.

As a general rule, the ideal length-to-width ratio of a fusiform elliptical excision is 3 to 1; this maximizes the probability of achieving the ideal angle at the apices of the ellipse of 30°. However, the ratio can vary depending on the inherent characteristics of the skin in various anatomic locations, as well as the elasticity of the skin. The incorporation of the ideal ratio and ideal angle of the fusiform ellipse enables the repair to be performed without leaving an undesired pucker of redundant skin, also called a dog-ear, at either end of the closure.

The fusiform ellipse is usually placed along the relaxed skin tension lines (RSTL). Repairs designed along RSTL reduces the tension on the wound edge, resulting in a better scar.

Variations of the fusiform ellipse include the curved ellipse, “lazy-S” excision, and M-plasty. These surgical techniques take into consideration that RSTL do not always fit neatly into straight lines and allow for customization of the scar to anatomic regions.