Scar revision is an integral part of complete skin cancer management. There are three main aims of managing skin cancer:
Cure the patient of the skin cancer
Maintain or restore function to the site if it is impaired
Make the final appearance as good as possible having achieved the first two objectives.
Scar revision comes into the third aim of skin cancer treatment. Often after a skin cancer is removed there is a large skin defect. This is usually closed at the time, though not always. In the first instance we try to achieve a good skin cover.
Sometimes when the wound settles down there is not a good match of skin, or the skin is too bulging or indented. Sometimes the left and right sides of the face are no longer good matches because a skin cancer was removed from one side. Sometimes the scar tightens up and this pulls the skin out of shape somewhat. Sometimes the skin surface is rough or uneven.
All of these things can usually be improved. We call this scar revision and it can be an important final stage or stages of managing a skin cancer. Some interventions your doctor may discuss with you to attempt to improve your scar include:
Dermabrasion. This is a process of smoothing out the skin by resurfacing the outer layers.
Scar lengthening. This involves excising into the scar and manipulating it to reduce a contracture.
Thinning. This involves surgically reducing a bulge in the skin repair.
Fillers. This involves injections to thicken up the skin.
Scar excision. One can remove the old scar to re-cut and suture a new scar.
Steroid injections. This can help reduce thickening under the skin.
In most cases when something more than injection is planned, local anaesthetic is required.
Scar revision is not cosmetic or plastic surgery. It is the important and often needed final stage of skin cancer management. It is therefore part of the training that ACSCM includes in a complete program of skin cancer education.
Dr. Anthony Dixon