Hours after Norman "Nob" Hill, 67, had melanoma surgery that left a silver-dollar-sized wound on his right cheek, the lab report came back with good news. But Hill didn't go home right away.
"Following my melanoma surgery, my surgeon asked me if I minded staying around until he finished with his other patients," said Hill. "I told him, "Doc, you just told me I'm cancer-free. I'm ready to rock and roll."
In other words, he was happy then to do whatever the doctor asked. And now, a year later, he's glad he did. Not only is he cancer free, he's also looking good.
More than 98 percent of patients who receive treatment for early-stage melanoma that has not affected the lymph nodes survive more than five years. With this improved survival rate comes attention to quality-of-life issues, including what it might mean to have to live with visible scars, particularly on the face, says Joseph Sobanko, the University of Pennsylvania dermatologic surgeon who performed Hill's procedures.
"The thing about scarring is that it's a very important and under-recognized topic," said Sobanko, who has conducted research on the topic. "Scarring can have a great effect on the psycho-social life of a patient no matter what their age or gender."
"Scars are a particular challenge for people with skin cancer on the face," he said. "They are happy when the cancer is out, but then they may feel shy about treatment of scars."
Given the importance placed on physical appearance in society, procedures to camouflage or prevent scars should not be seen as elective, Sobanko said.
"Physical appearance plays a major role in how patients relate to others, so scarring that alters physical appearance – even if some might see it as minor – can have a negative impact," he says. "Reducing scarring can be essential to a better quality of life."
When it came to Hill's wound, Sobanko had a plan – a four- to five-hour procedure that involved stretching the skin on his face around the wound and manipulating it until it could be stitched together. The hope was that when the surgery site healed, any scar lines would blend in with Hill's smile.
Hill's surgery took less time than Sobanko had predicted: about three hours. The wound was sealed with 144 closely packed dissolving stitches, mostly on the underside of the skin. With Novocain for an anesthetic, Hill remained awake during the entire operation.
"When Dr. Sobanko finished he told me it was very successful. But he also told me that no matter what, in the future I'll do anything you want to make it look correct," said Hill, who lives in Avalon, N.J.
"The best scars that we can produce are when we try to camouflage scars so no one else can see them," Sobanko said. "But every time you cut into the skin, any incision or suturing will create a scar."
When it comes to early results, patients should try to manage their expectations.
"Patients need to recognize that time can make a big difference in scarring," Sobanko said. "Scars almost always improve with time. Patience is paramount. One week out we may say a scar looks great, but we recognize it won't look great to a patient."
During the first stages of healing, patients can help reduce scarring by limiting sun exposure and keeping the area around the scar moist. While patients may buy scar-reducing creams, Sobanko says no research proves that silicon or herbal-based creams are any better than Vaseline.
Most scars take about a year to heal completely.
Sobanko also works with existing scars. He divides these scars into two categories: those with abnormal color and those with abnormal contour, including keloids. People with light skin may develop red or brown scars, which can be treated with lasers that reduce the discoloration. For scars that are hypertrophic, or raised, lasers, injectables, and, occasionally, surgical procedures can reduce the impact of the scarring.
"A decade ago we might have surgically removed keloids or used dermabrasion to sand down skin to smooth them out, but both of these procedures often produced unpredictable results," Sobanko said. "Now we can use fractional lasers that can target injured skin and stimulate cells to produce collagen to help raise the scars and camouflage them better."
Not surprisingly, Sobanko's research finds that young people are often most affected emotionally by visible scarring, particularly on the face.
"If you can get a young patient to heal imperceptibly, quality of life is much improved," he said.
"But scars shouldn't carry a stigma for anyone," he said. "For patients who are concerned about scars, there is great technology out there. They should seek a trained professional who is sensitive to their needs. Improvement of the scar can improve the quality of their lives."
Three months after the operation, Hill said, the redness from the injury to the skin had faded and the swelling had gone down. After a year, he said, the scar looked "beautiful."
"People who see me don't know that there was a scar there at all," he says.
"They often don't realize anything has happened."