How do I reduce scaring from my recent skin cancer removal?

The Melanoma Scan doctor and nurse will give you detailed instructions on how to care for your wound to reduce scarring. 

Any procedure to remove a skin cancer will cause a scar and some people will scar more than others depending on their tendency towards keloid scarring and their skin type.  Scars tend to settle to a pale mark, either a oval area after curettage and cautery or as a line from excisional skin surgery.  If there is a lot of background sun damage, this pale area can become more prominent and noticeable.  Background sun damage can include solar keratosis, freckles, pigmentation, age spots and telangiectasias (dilated small vessels on the skin surface).  All of these lesions can be treated, either as individual lesions or as part of a field treatment such as efudix, PDT, lazer, IPL or skin peels. 

All these treatments can help to improve the outcome after surgery by making the scars less noticeable.

Alternatively, there may be an abnormal scar that forms after surgery, such as hypertrophic scarring or keloid scar.  Hypertrophic scarring is an abnormally thickened scar that does not extend beyond the initial injury, and keloid scarring is an abnormally thickened scar that extends beyond the original injury.  In some people keloid scars can occur after even minor injuries, such as a piercing or even a pimple that has been squeezed or traumatised (scratched), so its hardly surprising that keloid scars can form after skin cancer surgery.  Treatments include massage of the wound, taping with micropore or fixomul tape, silicone gels such as strataderm, and silicone taping. 

If non surgical treatments fail to improve the scar then surgical treatments may be used such as steroid injections, shave excision and steroid injection, and re excision with or without steroid injection into the wound.

Shave excisions

With Shave excisions, the best results can be achieved using moist wound healing, using antibiotic ointments such as chloromycetin ointment or otocomb on high-risk areas for infection, or using strataderm or stratamed silicone containing gels for areas at risk of keloid scarring.  For some areas simple moist wound dressings using Vaseline, antiseptic creams or pawpaw ointment may be a low cost and suitable alternative.  Your doctor will recommend the treatment that he believes is most suitable for your particular wound and situation.

Ellipse excisions

With ellipse excisions, taping is an important aspect of wound care to prevent a stretched-up scar despite the support of the deep sutures. Equally important is abstaining where possible from exercise for up to 6 weeks following surgery.  That may not always be possible with people engaged in manual work, but often with care and getting assistance with lifting and carrying, stretching of the scar can be minimised.

Keloid scarring is a feared outcome for all excisions, however, is very uncommon outside of a small group of people who appear to be prone to them.  In this group, silicone gels are utilised and the wound is reviewed 3-4 weeks after surgery to see if there is any sign of keloid formation, which can often appear after apparently normal early healing as a raised red itchy and uncomfortable scar.  Occasionally steroid injections may be used to halt keloid formation or reduce an established keloid scar, but the results are not always satisfactory in this keloid prone group of patients.

Melanoma Scan - Skin Cancer Clinic

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