Bloodless nasal alar surgery: another innovative use of the chalazion clamp.

Cutaneous tumors located on the nasal ala often pose challenges to a Mohs surgeon because of the ala’s unique anatomy. Hemostasis is difficult and, if not accomplished quickly and fully, leads to an obscured surgical field. Intraoperative trauma can result in both patient and surgeon due to frequent blotting and blood clearing attempts in a small anatomic area. The usual method of pressure application with gauze also leads to an obscured field and operative delays. Electrocautery is effective but results in charred and necrotic tissue in the wound, thereby risking potentially poor scarring and delayed healing in a cosmetically sensitive location. In addition, another problem in alar surgery is stabilization of the alar structure because it is firm but collapsible and contains a cosmetic unit–free margin.