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What Causes a Pincushion Scar in Flap Surgery and What Are the Options for Repairing It?

Five weeks ago I had a large skin cancer removed from my temple next to my eye using a flap repair. A pincushion scar has resulted and a friend who is a nurse suggested that this is trapped fluid and will dissipate especially if I keep squeezing it towards the side of the pincushion with no join. I've been doing this constantly for several weeks with no change and I feel that the 'pincushion' contains fat rather than fluid. What are the options for correcting this?

Doctor Answers 2

Treating pincushioning in a flap after skin cancer or Mohs surgery

August 30th, 2013
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Your friend may not have given you good advice. It would be very sensible for you to go see the Mohs surgeon you saw for this and have him/her take a look at it. Scars need time to mature and they are fragile in the beginning so you might be harming the way it heals by doing what you are describing. Also there is often swelling after a procedure which gradually improves with time. A visit to your Mohs surgeon will help address and help you care for the scar properly. 

Omar Ibrahimi, MD, PhD
August 30th, 2013

Treating pincushioning in a flap after skin cancer or Mohs surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your friend may not have given you good advice. It would be very sensible for you to go see the Mohs surgeon you saw for this and have him/her take a look at it. Scars need time to mature and they are fragile in the beginning so you might be harming the way it heals by doing what you are describing. Also there is often swelling after a procedure which gradually improves with time. A visit to your Mohs surgeon will help address and help you care for the scar properly. 

Omar Ibrahimi, MD, PhD

Stop what you are doing and see your physician

August 29th, 2013
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Flaps are especially vulnerable to infections and possible necrosis even. It is important to keep your hands away from your site, and to see your surgeon if you have questions. I don't care that your friend is a nurse - Mohs repairs are very technical and no one should be giving you advice on caring for it except your surgeon. If you have questions about potentials for scarring and how to improve it (at only 5 weeks out this really shouldn't be a concern because there's too much else still going on under the skin), you can ask your trained Mohs surgeon. Keep your hands away from it and under no circumstances should you be squeezing and moving it around. You could be damaging the flap beyond repair and keeping it from healing and taking, which could result in much worse than a pincushion scar.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

F. Victor Rueckl, MD
August 29th, 2013

Stop what you are doing and see your physician

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Flaps are especially vulnerable to infections and possible necrosis even. It is important to keep your hands away from your site, and to see your surgeon if you have questions. I don't care that your friend is a nurse - Mohs repairs are very technical and no one should be giving you advice on caring for it except your surgeon. If you have questions about potentials for scarring and how to improve it (at only 5 weeks out this really shouldn't be a concern because there's too much else still going on under the skin), you can ask your trained Mohs surgeon. Keep your hands away from it and under no circumstances should you be squeezing and moving it around. You could be damaging the flap beyond repair and keeping it from healing and taking, which could result in much worse than a pincushion scar.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

F. Victor Rueckl, MD
*Treatment results may vary

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.