Skin Cancer Surgery: Patients Fear Scars More Than the Procedure

PATIENTS about to have a skin tumor removed worried more about the scar it would leave than about the operation itself.

That was the finding of a prospective, single-center observational cohort study of 100 consecutive patients undergoing skin tumor excision. Before surgery, each patient completed a questionnaire rating operative anxiety and scar concern on separate 0 to 10 numeric scales.

Scar concern before skin cancer surgery scored significantly higher than operative anxiety. The median scar concern score was 3.0 (interquartile range, 0 to 5), compared with 2.0 (interquartile range, 0 to 4) for operative anxiety (p = .006). The authors note that the favorable prognosis of many skin cancers may create a paradoxical situation in which appearance matters more to patients than the procedure itself.

Scar Concern Before Skin Cancer Surgery: Who Worries Most

Several patient and tumor factors were linked to higher scar concern. Women reported greater concern than men (p = .014). Younger age was associated with more concern, with scores decreasing as age increased (p = .008). Anatomical location also mattered (p = .010).

Histological subtype, by contrast, showed no significant association with scar concern (p = .639). In other words, worry about appearance did not track with the type of skin tumor being removed.

Prospective data directly comparing these two dimensions of preoperative distress have been scarce, which makes the comparison a useful addition for dermatologic surgery teams.

What It Means for Preoperative Counseling

The authors conclude that scar concern was tied to identifiable psychosocial and anatomical factors. They say the results support targeted, appearance-focused preoperative counseling for patients with higher scar concern.

For clinicians, that suggests asking about scarring expectations as routinely as asking about nerves, especially for younger patients, women and those having excisions at higher-concern body sites. Recognizing that scar concern exceeds operative anxiety allows clinicians to refine their preoperative consultations significantly.

Reference
De Deurwaerdère A et al. Scar concern exceeds operative anxiety in oncologic dermatologic surgery: a prospective cohort study. Dermatol Surg. 2026. DOI: 10.1097/DSS.0000000000005423.