Surgery Options for Skin Cancer Scars

Scarring is the natural process that occurs as the layers of the skin heal, whether from trauma, surgery, burns, or severe acne. While doctors treating skin cancer do their best to minimize scarring, some scars after skin cancer treatment can be unappealing, unsightly, or even disfiguring. Fortunately, there are options to minimize or reduce scarring, including topical treatments and surgery.

Plastic surgery for scars

People who want to address their scars after skin cancer treatment often visit a plastic surgeon, a specialist who is trained in the repair, reconstruction, or replacement of physical defects. The main goal of using plastic surgery for scar revision is to make the individual more comfortable with his or her appearance, even if the scar cannot be completely alleviated.

While there are several treatment options available to address scars, none is perfect, and the plastic surgeon will want to understand the individual’s dissatisfaction with their scars, any functional limitations they have as a result of the scar, and their expectations following scar treatment. Other considerations that impact treatment choice include the location of the scar and the potential for functional impairment after scar revision, such as increased tension or decreased range of motion. In some cases, no treatment may be the best solution, if the scar cannot be reasonably improved or if expectations cannot be met.¹

Surgical procedures for scar revision

There are several surgical procedures that may be used to minimize scars, including:

• Fusiform excision – a procedure in which the surgeon removes the scar in an elliptical pattern and tissue expanders may be placed around the scar to encourage growth of healthy, non-scarred skin and closure of the elliptical excision.
• Shave excision – a technique used on scars that are elevated or raised above the surrounding tissue and in which the elevated portion of the scar is shaved off to make the scar level with the surrounding skin.
• Z-plasty – a surgical method in which two triangular flaps (like the shape of a Z) are cut and placed in the other’s original position. Z-plasty allows for scars to be repositioned to an area with less tension or to make the scar less visible by decreasing the scar length.
• W-plasty – a procedure used to make a lengthy scar irregular and is performed by making consecutive small triangular flaps on opposite sides of the scar, which are attached after removing the scar tissue in the center.
• Geometric broken line closure – similar to a W-plasty, this procedure breaks up a linear scar and makes it less visible by creating regular, patterned, geometric shapes around the scar.
• Skin flaps – a surgical technique where healthy skin is taken from another area and grafted in the site of the original scar.^1,2

Setting expectations

It’s important to understand that no scar revision therapy can completely get rid of a scar, although treatments can make scars less noticeable. Talk to a plastic surgeon about your options and ask to see examples of their work to get an idea of what to expect.