General

Keloid scar


What is it?

A benign tumour like scar reaction that has extended beyond the boundaries of the original scar.

What is the cause?

  • genetic (dark skinned people have a higher risk)

What are the symptoms?

  • itchy painful scar
  • enlarging lump

What are the treatment options?

  • Step 1: silicone sheet therapy (at least 23 hrs a day for 6 months); and pressure eg compressive earrings
  • Step 2: steroid injections
  • Step 3: surgery

When should I see a Surgeon?

  • when you are considering steroid injections or surgery

 Lipoma

What is it?

A benign subcutaneous fat cell tumour.

What is the cause?

  • idiopathic
  • genetic
    • some people experience numerous painful lipomas (Dercum’s disease).

What are the symptoms?

  • mobile slowly enlarging subcutaneous lump
  • most are painless
  • can be painful

What are the treatment options?

  • surgery

When should I see a Surgeon?

  • when it concerns you enough to require surgery
  • persistently painful rapidly growing and deeper subcutaneous lumps may be a sarcoma and need urgent surgical review

Scar revision

What is it?

Surgery to improve the contour, colour, or thickness of a scar.  Scar revision may also be necessary when a contracted scar is causing a functional problem eg incomplete finger extension.

What is the cause?

  • genetic
    • some people have a tendency to form hypertrophic or keloid scars (see above). This often runs in the family.  Dark skinned people have a higher risk.
  • age
    • younger skin often forms thicker and more reactive scars
  • tension
    • scars in areas of tension will more commonly produce widened and hypertrophic scars
  • complication
    • wounds that have become infected or have dehisced may form bad scars.

What are the treatment options?

  • improve the colour
    • red – laser
    • hyperpigmented – laser
  • improve the contour or width
    • surgery

When should I see a Surgeon?

  • when a scar has had 6-12 months to mature and you are unhappy with the outcome

Skin cyst

What is it?

A subcutaneous cyst that arises from epidermal cells trapped in deeper layers of the skin (epidermal inclusion cyst).  Commonly known as a “sebaceous cyst”.

What is the cause?

  • primary – related to a hair follicle
  • secondary – skin cells can become trapped in deeper layers after trauma eg a laceration

What are the symptoms?

  • enlarging subcutaneous lump
  • discharges cheesy white keratin
  • commonly becomes infected

What are the treatment options?

  • surgery
    • acute infection – abscess drainage
    • chronic stable cyst – formal excision

When should I see a Surgeon?

  • if it is acutely infected
  • if it bothers you enough to warrant surgery