Handmade double-blade scalpel for Mohs surgery

Clinical Challenge: Obtaining Mohs surgery stages can be challenging in certain areas with loose or flaccid skin such as the eyelid. This might be helped by double-blade scalpels that make the cut on both sides of the stage simultaneously, while the skin is still tightened. Some authors described the use of scalpel handles with two notches for two blades, although they might not be available in all hospitals.1 Arnon et al.2 described a simple way of making a double-blade scalpel by attaching a second blade to a common scalpel handle with tape. However, the bond relies on the tape, and we found that the use of two scalpel handles provides a more stable union.

Solution: One scalpel is attached to the handle as usual, and to keep a 3 mm distance between the blades, the notch of both handles must face each other (Video 1). Therefore, the second blade should be placed oppositely so both blades face the same direction, which although it does not allow for a perfect fit, keeps the scalpel strongly fixed to the handle. Both scalpels are attached with adhesive tape, that can be sterile, allowing for a stable 3 mm distance between blades. We found this handmade double-bladed scalpel especially helpful in obtaining spaghetti Mohs stages on difficult areas where maintaining a tightened skin after the first cut is not easy, although it can also be used for conventional Mohs surgery.

1. Choi KW, Lee YK, Kim YH, Lee CW, Kim KH. Surgical Tip: The Double-Bladed Scalpel in Mohs Micrographic Surgery. Ann Dermatol. 2008 Jun;20(2):86-9.
2. Arnon O, Pagkalos VA, Xanthinaki AA, Silberstein E. Double-bladed scalpel in mohs micrographic surgery. ISRN Dermatol. 2012;2012:617314.