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Certain surgical technical principles will improve the chance of success and minimize the risk of local or distant seeding of tumor cells. The tumor should be draped off from the rest of the surgical field. Surgeons should attempt to not contact ulcerated or open areas of tumor with gloves or instruments. Sharp dissection is preferred over blunt dissection, when possible, as this will decrease the likelihood of leaving neoplastic cells within the patient and decrease the risk of straying from the preestablished margin. Tension on skin closures should be avoided whenever possible, especially in cases that have undergone radiotherapy. Proper knowledge of tension‐relieving techniques such as tension‐relieving sutures and flaps can assist in closure (Soderstrom and Gilson 1995; Aiken 2003); however, tension‐relieving skin incisions are contraindicated after removal of a neoplasm. If an indwelling drain is deemed necessary in a tumor resection site, the drain should be located in an area that can be resected during a subsequent surgery or in an area that will not compromise radiation therapy and can easily be included in the radiation field. Lastly, control of hemostasis and prevention of seroma or abscess development due to dead space is encouraged. Seromas or hematomas following an incomplete resection allow tumor cells to gain access to areas beyond the surgical field as these fluids may be widely dispersed throughout the subcutaneous space during movement.

To decrease the risk of recurrence after tumor resection, there are several techniques that the surgeon should practice. For tumors that have been previously biopsied or for which a drain has been placed, the biopsy tract and/or drain hole need to be removed en bloc with the tumor. Similarly, adhesions should be removed en bloc with the tumor, when possible. Leaving any of these can result in an increased risk of tumor recurrence. Additionally, when establishing a margin during surgical dissection, this margin must be maintained around the periphery of the tumor down to the deep margin. Straying from this may result in an incomplete resection. Similarly, the pseudocapsule present around a tumor should not be penetrated, as this pseudocapsule is constructed of a compressed layer of neoplastic cells (Soderstrom and Gilson 1995). Seeding of these cells will likely result in recurrence, and healing may be inhibited. Lastly, it is important that a new set of instruments, gloves, and possibly drapes be utilized for closure of a wound created by tumor removal or reconstruction of a wound. This principle applies to the removal of subsequent tumors on the same patient, as these items should not be transferred from one surgical site to another.