There was no significant difference found in patient assessment or physician assessment for scar halves treated with ablative laser therapy during the day of surgery and 14 days following surgery.
Clinical Pearls
This study sought to determine whether ablative laser therapy for skin cancer surgery scars is more effective when done during the day of surgery or 14 days after
30 patients were included with skin cancer excisions requiring a linear complex closure on the upper or lower extremities. Half of each scar was treated with a fractional CO2 10,600 nm laser during the same day of surgery and the other half was treated 14 days post-operatively. 6 months following each excision, the patient’s assessment as well as a blinded physician’s assessment on each scar half was determined
There was no significant difference found in patient assessment or physician assessment for scar halves treated with ablative laser therapy during the day of surgery and 14 days following surgery
Discussion:
When treating skin cancer, the development of scars post-excision is often inevitable. There have been many techniques recommended to patients to minimize scars, however, distressing scars to patients often still persist. The use of ablative resurfacing via a CO2 laser has been found to be effective in treating post-surgical scars. This study sought to answer the question if there is an optimal timing to ablative laser therapy for surgical scars.
This was a prospective, randomized, split-scar, physician blinded study involving 30 surgical scars on patients’ limbs. 30 patients of Fitzpatrick skin type I or II with skin cancer excisions requiring linear complex closure on the upper or lower limbs were recruited for this study. Importantly, each wound was closed by a single, experienced dermatologic surgeon. Following placement of buried subcuticular monofilament 4-0 poliglecaprone 25 sutures, a randomized half of each wound was treated with 2 passes of a fractional CO2 10,600 nm laser. Subjects were then seen again at post-operative day 14 where the other half of each wound was treated with the fractional CO2 laser as described previously. Subjects were then seen 6 months post-operatively where each patient’s opinion of scar appearance was obtained, a blinded physician assessed each half of each scar using a modified Manchester Scar Scale (MMSS), and three millimeter punch biopsies were taken of each scar half
The results of the study found that 54% of patients preferred the appearance of the scar-half treated at Day 0 (p=0.58). The mean MMSS for scar halves treated at Day 0 was 8.4 (range 7-10) while it was 8.7 (range 7-10) for scar halves treated at Day 14 (p=2.8). Overall, this study demonstrated that fractional ablative laser resurfacing with Co2 laser during the same day of surgery and at 14 days post-operatively yield similar results. Weaknesses of this study include a lack of generalizability to darker skin types given all patients were of the same, lighter skin type as well as 4 subjects being lost to follow up.
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