Learn to be Wary of Scars that look Scary

byNicky Phillips
^{(creative writers at http://www.morewriting.co.uk)}

You don't know till someone tells you, do you? I felt a bit of a fool really, but it turned out there was no need.

Gary, my boyfriend, had insisted that I should see my GP about a mole I'd had for years, which had changed recently in appearance - it had grown, darkened in colour and become raised. The GP referred me to a dermatologist who, before examining the mole, offered to check me over, give my skin an MOT, as it were.

"Why not?" I thought. So I stripped down to my underwear and the dermatologist carefully checked me over, looking through a special lens when she noticed something of interest. She told me that she would remove the mole that had caused me concern and found another, smaller, one on my breast, which she said she'd remove at the same time.

"Two for the price of one!" she joked, reassuring me that neither looked troublesome. They would, however, be sent for analysis, just to make sure.

She continued examining my skin.

"What have we got here?" she asked, instantly making me wonder what on earth she'd noticed. I was lying on my back with my eyes closed at the time.

"Oh yes," I mumbled, realising she'd spotted my scar, "is that normal?".

"No, not at all, it's keloid. Change of plan: I won't remove the smaller mole from your breast in case that does the same: the scar may be larger than the mole."

"Could you tell me about keloids, please?" I asked, kicking myself for not having consulted someone about it sooner.

I'd wondered since the original surgery two years earlier whether my red, raised, lumpy scar should be like that, but hadn't wanted to make a fuss or consult my GP over something comparatively minor which may - for all I knew - have been within the boundaries of normality. I was glad to have the chance to discuss it at last, as Gary and I were hoping to have a beach holiday in Greece and I was embarrassed about other people seeing it.

"Yes, of course. When a wound heals, it leaves a scar. A keloid is a special type of scar: one that grows too much and can become larger than the wound itself, spreading outside the original area of skin damage."

"Well, it's always tender and sometimes throbs a bit, but I thought that was because I had major surgery and that it would improve over time. What should it be like?"

"Well, it shouldn't give you any discomfort and should just be a pale, flat pencil line. Yours is more like a knotted rope! Does it itch?"

"No, thankfully not."

"You're lucky then because some cause intense itching."

"What makes it happen? Is it something I've done - or haven't done - or something to do with the procedure I had?"

"No, not at all. The reasons keloids occur aren't fully understood. Most people never suffer from them; others get them after the most minor of injuries - even an acne spot or chickenpox scar. Keloids affect dark skinned people much more easily than those with a paler skin; they're especially common in people with black skin. They can crop up anywhere but are most likely to do so on the upper chest and shoulders and also on the earlobes."

"Is this something new for me then?"

"Well, they're most common between the ages of 10 and 30 years, but if you've had one before or if members of your family have had them, then you're at extra risk of getting one - hence my decision not to remove the smaller mole."

"Are they dangerous in any way? I mean, can they change and become cancerous, for example?"

"No, there's no risk of that happening."

I lay quietly while she finished examining me. In my mind, I was going over what she'd said. I'd asked Gary on loads of occasions whether he thought I should seek advice, but he always said he thought the scar would settle down in time. Was it too late to do anything to improve it, I wondered.

As if reading my mind, the doctor moved across to her desk.

"I'll write you a prescription for some silicone gel. Apply a small amount daily; I'm optimistic it may help the scar flatten, soften and become paler. It should also relieve any discomfort or itching."

"If not, are there any other ways of treating it?"

"You could have a further operation, but that would be likely to lead to an even bigger keloid forming. It's possible to have steroid injections into the scar, but they're not always successful. Early keloids can be treated with long-term compression with pressure dressings or by freezing with liquid nitrogen. Another option to help a keloid flatten is to put a silicone sheet over it at night for several months. However, it's only fair to point out to you that treatment is difficult and not always successful."

I nodded.

"Let's see how you get on with the gel - I think that's the best course of action for you. If it's not successful, we can look at other options later."

I told her how foolish I was feeling for not consulting her sooner, but she said keloids were often found by chance while something else was being investigated - as in my case.

On the way home, I collected the silicone gel from the pharmacy. I used it daily from then on.

Gary was delighted I'd discussed it at last and hopeful that the gel would improve the scar - not for his sake, because it didn't bother him at all, but because he wanted me to be more comfortable with it.

Four weeks later, I returned to the dermatologist to have the mole removed. She asked about the scar; I told her it was paler in colour and may have begun to flatten a little. She told me to continue to use the gel long-term as it could take up to six months to show significant improvement. I was also to use it on the scar from the mole removal, once healed.

When Gary arrived home, I told him about the appointment.

"Oh, and something else," I added.

"What's that?"

"I went online after I got back and booked us a fortnight in Crete."

"That's great," he said. Smiling, he paused for a moment before adding, "Sometimes these things you don't know till someone tells you can be good news: a fortnight in Crete with the girl of my dreams certainly is!"