Question: Will I have a scar?
Back before there even was an ‘online’ where online dictionaries could be found, I relied on the 24th edition of Stedman’s Medical Dictionary that I purchased at the beginning of medical school. On page 1258 it defines
scar – “the fibrous tissue replacing normal tissues destroyed by injury or disease”
Every time – every single time – that an incision is made in the skin after birth – (the skin of babies in utero is a special exception) – there will be a scar. The skin is made of three layers – epidermis, dermis, and subcutaneous fat. Whenever a wound of any kind (such as a scalpel incision or burn or deep scrape) passes through the epidermis and into the dermis (about 0.1 millimeter beneath the surface – or the thickness of a sheet of paper), wound healing processes begin that lead to the formation of “fibrous tissue” – the hard tissue made of fibroblast cells and collagen protein – that makes up a scar. Nobody can prevent that from happening.
Because a scalpel will be used to cut beneath your cancer, which extends into the dermis, by definition, there will be a scar.
However, the question that I believe patients are really asking is
Question: How noticeable will my scar be?
Answer: It depends – and – as hidden as possible
My primary surgical goal is to remove your cancer so that it does not come back. My secondary goal is to leave behind as much of you and your normal skin as possible to achieve the best appearance after healing.
Patients and I decide together to let about 20-25% of wounds heal on their own (often called ‘second intention healing’ or ‘granulation’). Sometimes, second intention healing is chosen because the final wound will look as good or better than a sutured wound – with far less trauma to the skin. Smooth, light pink scars form in 4-12 weeks, depending on size, depth, and location on the body. Second intention healing looks the best in concave (bowl-shaped) areas such as the inner corners of the eyes, behind the ears, in the bowl of the ears, or small wounds in the crease of the nose.
Some patients are not concerned with scar appearance and choose not to have a more complex procedure (like a tissue rearrangement, known as a flap, or a graft) performed on an area like the tip of the nose or rims of the ears. This wound will heal with a sunken-in appearance that casts a shadow.
Over 70% of wounds are sutured together either in a line (often slightly curved to follow natural curves on the face, such as smile lines) or with a flap, a tissue rearrangement the involves making ‘puzzle pieces’ of nearby loose skin that is still partially connected to blood vessels. Flaps are only performed if there is no good option to sew something together in a line.
With all sutured wounds, there will initially be swelling, redness, and often bruising. But these decrease gradually over days to months. In the end, the majority of wounds heals well and is hidden in natural skin lines when possible. There are options to improve scar appearance that would be discussed with you on follow-up visits. However, the vast majority of patients report satisfaction with scar appearance and comment on how relatively unnoticeable they are compared to expectations.
– Dr. Tom McGovern
Fort Wayne Dermatology