Plastic and Reconstructive Surgery: Skin Disorders & Procedures

Scar Revision | Skin Cancers

Scar Revision

Large noticeable scars may become less visible over time and some scars can be treated with steroids to relieve symptoms such as tenderness and itching. For these reasons, many plastic surgeons recommend waiting a year or more before undergoing scar revision.

Our UF plastic surgeons will discuss the possible methods of treating your scar, the risks and benefits involved and the possible outcomes. Because insurance doesn’t usually cover cosmetic procedures, it is important to check with your insurance carrier prior to scheduling a consultation. However, if a scar revision is performed to minimize scarring from an injury or to improve ability to function, the procedure may be partially covered by insurance.

The surgeons of UF Health Plastic Surgery at Jacksonville treat the following scars:

Keloid scars are described as thick, puckered, itchy clusters of scar tissue that grows beyond the edges of a wound or incision. Often red or darker in color than the surrounding skin, keloids appear after a wound has healed and form when the body continues to produce collagen, a tough, fibrous protein.

Keloids can be treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this may also shrink the scar. If steroid treatment does not reach the desired outcome, the scar tissue can be cut out and the wound closed with stitches. This is generally an outpatient procedure performed under local anesthesia. Because keloids have a tendency to recur, repeated procedures may be required every few years.

Hypertrophic scars are similar to keloids because they are thick, red and raised. Hypertrophic scars remain within the boundaries of the original wound or incision, while keloids spread beyond. They often improve on their own over time or with the help of steroid applications or injections.

Hypertrophic scars can often be improved surgically. The procedure involves removing excess scar tissue and repositioning the incision so that it heals in a less visible pattern. Depending on the scars location, this surgery may be done under local or general anesthesia. Steroid injections may be administered during surgery and at intervals for up to two years afterward to prevent the scar from reforming.

Contractures develop when the loss of a large area of skin forms a scar that pulls the edges of the skin together. This contraction process is often caused by burns or other significant injuries. Contractures may affect adjacent muscles and tendons which causes the restriction of normal movement.

Correcting a contracture usually involves cutting out the scar and replacing it with a skin graft or a flap. In some cases, if the contracture has existed for some time, physical therapy may be necessary after surgery to restore full function.

Facial scars, whether hypertrophic or not, are frequently considered a cosmetic problem. There are several ways to make a facial scar less obvious. Often it is simply cut out and closed with tiny stitches, leaving a thinner, smaller scar. If the scar lies across the natural skin creases, it may be repositioned to run parallel to these lines, making it less noticeable.

Some facial scars can be softened using a technique called dermabrasion, a controlled scraping of the top layers of the skin using a hand-held, high-speed rotary wheel. Although it won’t completely erase a scar, dermabrasion leaves a smoother surface to the skin.

With any kind of scar revision, the degree of improvement depends on the size and direction of your scar, the nature and quality of your skin, and how well you care for the wound after the operation. Some scars appear worse following surgery and final results may not be apparent for a year or more.

Skin Cancers

Skin cancer is the most common type of cancer and is defined as the abnormal growth of cells in the skin. It is almost always cured when it is found early and treated. If you notice changes in your skin or an abnormal lesion develops, it is important to consult your physician as soon as possible.

Most skin cancers are of the nonmelanoma type which is usually caused by too much sun exposure and by using tanning beds or sunlamps. Skin cancer usually appears as a growth that changes in color, shape, or size. This can be a sore that does not heal or a change in a preexisting mole.

There are two types of nonmelanoma skin cancer that are treated by UF Health Plastic Surgery at Jacksonville:

Basal cell carcinoma usually affects areas that get the most sun – the head, neck, back, chest, or shoulders. The nose is the most common site. Signs of basal cell carcinoma can include skin changes such as a firm, pearly bump with tiny blood vessels in a spider-like appearance; red, tender, flat spot that bleeds easily; small, fleshy bump with a smooth, pearly appearance, often with a depressed center; scar-like patch of skin, especially on the face, that is firm to the touch; a bump that itches, bleeds, crusts over, and then repeats the cycle and has not healed in 3 weeks; or change in the size, shape, or color of a wart or mole.

Squamous cell carcinoma usually affects the face, head, or neck. Signs of squamous cell carcinoma include any persistent, firm, red bump on sun-exposed skin; patch of skin that feels scaly, bleeds, or develops a crust; a skin growth that looks like a wart; or a sore that does not heal or an area of thickened skin on the lower lip, especially if you smoke or use chewing tobacco or your lips are often exposed to the sun and wind.

The most common treatment for nonmelanoma skin cancers is to numb the skin and cut out the cancer. The procedure is done while the patient is awake. A sample of the growth is then sent to a lab to see if it contains cancer cells, this process is called a biopsy. If it does, then the appropriate treatment is administered to remove all of the cancer. After treatment, you will need regular checkups, because having skin cancer once means you are more likely to get it again.

In addition to treating nonmelanoma skin cancers, our UF surgeons also treat the most serious form of skin cancer known as melanoma.

Melanoma can affect the skin only or, if not found and treated early, it can spread to the organs and bones. Spending too much time in the sun is a key factor in developing melanoma, which causes normal skin cells to grow out of control and attack the tissues around them.

The most important sign of melanoma is any change in the shape, size or color of a mole or other skin growth, such as a birthmark. Melanomas can be found anywhere on your body; however, most of the time, they are discovered on the upper back in both men and women and on the legs of women.

Melanoma looks like a flat, brown or black mole that has uneven edges and is usually in an irregular or asymmetrical shape. Unlike a normal mole or mark, a melanoma can change color, be lumpy or rounded, or become crusty, ooze, or bleed.

Melanoma is diagnosed when a biopsy reveals cancer cells are present. At that point, more tests are run to determine how far the cancer has spread and the appropriate treatment necessary. The most common treatment is surgery to remove the melanoma. If the cancer has not spread to other parts of the body, that is all the treatment needed for early-stage melanomas. For late-stage melanomas, cancerous lymph nodes may need to be removed.

Related: UF Health Cancer Center at Jacksonville