Scars and Treatment Marks Data

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Patients are rightfully concerned about scars. Scar tissue is fibrous collagen tissue made, in response to wounding of the skin, into a collagen-bearing layer beyond, i.e., above, the epidermis. Scar tissue is the glue that holds our bodies together following a wound. The author prefers to consider that plastic surgery scars are composed of at least two layers. The deep layer, hidden from public view, should be strong and as thick as necessary to remove tension on the visible layers. The visible layer should, of course, be placed in the proper skin fold or tension lines. It should be as free from tension as possible, so it does not stretch and become wider or more easily seen.

A patient's scar may be noticeable for several reasons including redness from blood vessels, whiteness from lack of pigment, altered light reflection from loss of skin markings, and pigment deposits, usually from sun exposure. Managing to reduce each of the factors before or following surgery is desirable for a good final result. Most scars assume their final form six to nine months following surgery. Sometimes more than one surgery is planned or is necessary to give the desired or proper final result.

With some of the more traditional or crude skin cancer treatment regimens such as scraping and burning as shown below, if the textbooks of treatment are properly followed, to get the highest cure rate a surgeon or dermatologist or doctor should destroy the greater amounts of tissue and thus leave the larger scars. For many reasons, some wrong and some right, most in the public will not accept this reasoning.

Scars can be visible or invisible to the naked eye. Visibility to the naked eye depends upon many factors, e.g., lighting, make-up, surrounding skin, age of the wound, surrounding blood vessels, sun-exposure to the wound and the observer's eyesight, training suspicion or expectations.

Whenever the skin is cut or violated beyond the epidermis (top layer), a scar results. There is no blood supply in the epidermis. But just below the epidermis, in the dermis, lie blood vessels and collagen. If bleeding results from a wounding of the skin into the epidermis, scarring will result. The only question is, just how noticeable is the scarring? Remember, "noticeable" depends not only on the quality of the wound but the on observer, as mentioned above.

Getting a good scar or result from a skin-cancer removal or cosmetic surgery depends upon many factors, not the least of which is the skill of the surgeon. Other factors include the size of the cancer, the size of the wound made to remove the cancer, the materials used to repair the wound (stitches, staples, butterfly bandages, etc.), the patient's ability to heal, the patient's care for the wound, and other chance factors such as infection. All of these factors must be taken into account when considering the final result. Most of these factors have been discussed in other subsections of the Web site.

For example, if skin cancer is the size of a pencil eraser (4mm) on the middle of the cheek and a straight-line scar is sought as the final result, then the following applies just as it appears in the textbooks of plastic surgery:

3mm margins must be taken around the cancer if it is a basal-cell cancer (some have recommended 5mm for a SCC), according to the textbooks, to keep the failure rate between 5 and 10%. This results in at least a 4mm+3mm+3mm=10mm hole to remove the cancer. To avoid puckering, the linear scar must be three to four times as long as it is wide, resulting in a 30-40mm-long scar. There are 25mm per inch. The final scar should be 1 1/2 inches long.

That is a noticeable scar on anyone's cheek. Only meticulous sewing and care for the wound will keep the result as small as possible. You can easily see why a surgeon might tend to reduce the margins (amount of normal tissue taken around a tumor), hoping to reduce the visible scar and still get the roots or peripherally spread cells. This failure to extend the margins of skin cancers and moles properly on the part of many surgeons only increases the failure rate of the surgery by increasing the chances that scattered cells or roots remain behind in the patient. Most patients do not know any better and would prefer a small scar, but their choice of a small scar really should be weighed against the chance the cancer will return and possibly cause a lot more damage. See Basal-Cell Cancer.

The public as a whole, because of an uninformed media and aggressive marketing among other factors, feels that lasers can eliminate scarring. In skin-cancer removal, this could not be further from the truth. See Laser. As far as improving an existing cancer scar, sometimes lasers can help. As we have previously mentioned, scars may be noticeable for several reasons including redness from blood vessels, whiteness from lack of pigment, altered light reflection from loss of skin markings, and pigment deposits, usually from sun exposure. The only factor in this list that lasers can manage well is redness from blood vessels. The pulsed dye laser can remove some of the redness, i.e., the blood vessels, from the scar but, once done, this may leave the scar white (lacking any color) and even more noticeable. Remember, our natural skin color consists of how light plays upon two major components: melanin (brownish) and hemoglobin (pinkness or redness). If a scar is already lacking in melanin, any laser that knocks out the pink or red may result in a white mark that may be more easily seen, depending upon the patient's background skin color in the location of the vicinity of the scar.

After having performed over 10,000 skin cancer and cosmetic surgery procedures, the author has a pretty good idea how someone will heal, judging from their skin texture, type, quality, location, age, etc. Even then, nothing is etched in stone. A guarantee implies 100% certainty. Even the best of skin-cancer surgeons cannot promise gratifying results more than 98% of the time. If your doctor does not provide you with a guarantee, he/she is likely just being honest and may be the best doctor for you.

While wounds are in the healing phase, scars may be especially noticeable. It is often advisable to see a make-up expert or someone good at a reputable store make-up department to get some tips on covering the scar. As time goes by, less and less make-up is needed. The author usually allows make-up to be used on his patients within two weeks after skin-cancer surgery and has a make-up expert on the premises. However, a good skin seal and tight accurate stitching are a must before make-up can be considered this early. Otherwise, make-up granules can get into a two-week-old wound and cause wound infection, breakage or inflammation. Ask your doctor first; every surgeon has a different technique and recommendations.

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