Scars and Wounds

Certain cancers, cancer treatments, and medical procedures can cause wounds and scars. Knowing how to take care of your wounds and scars can prevent problems in the future.

What causes wounds and scars?

Wounds and scars related to cancer or cancer treatment are most often caused by an incision (cut) made during a surgical procedure, by the cancer tumor itself, or by an accidental injury. Any of these things can cause physical injuries to the skin or tissues underneath.

Surgical wounds

Surgical wounds can vary depending on how the doctor closes the incision or cut. Stitches, staples, adhesive tape, or surgical glue can affect the way the wound looks and heals. The type of surgical closure the doctor uses will also depend on the type and location of the procedure.

Malignant wounds

If a cancerous tumor reaches the skin surface, it can break through and create an open sore (ulcerating wound) that doesn’t heal. This is known as a fungating tumor or a malignant wound. These wounds usually can’t be removed surgically and don’t heal.

Treatment-related wounds

Radiation therapy can cause serious skin changes (known as radiation dermatitis). If not taken care of, radiation dermatitis can develop into wounds.

Accidental injury wounds

Accidental wounds can be caused by any unintentional physical injury such as a cut, puncture, bruise, or burn from an object. They can also happen because of a fall, fracture, heat, chemical, or other cause.

Pressure sores are another type of accidental wound common in people with cancer.

Scars

When you have a wound on your skin or tissue, your body naturally creates collagen fibers to close the gap and heal the wound. These fibers form scar tissue.

There are many things that can affect what a scar looks like and how it develops. This includes the skin type, the location of the wound, and individual factors like your nutrition status and how well your immune system is working.

Types of wounds

Some of the most common types of wounds in people with cancer include:

• Post-operative surgical wounds (especially surgeries involving the abdomen)
• Pressure sores or injuries
• Cellulitis (a skin infection)
• Skin cancer lesions
• Radiation-induced wounds
• Extravasation wounds (certain types of chemo can cause severe tissue damage if it leaks out of the vein during IV infusion)
• Anal fissures (small tears that can turn into abscesses or fistulas if they become infected; this is most common in people with colon and rectal cancers)

Types of scars

The two main types of scars are keloids and hypertrophic scars:

• Hypertrophic scars are the most common. They don’t extend beyond the original wound.
• Keloids grow beyond the original wound and into surrounding healthy tissues. Keloids can affect anyone, but they are most common in Black and Asian American people.

Signs and symptoms

Wounds

• Pain
• Skin redness or bruising
• Scaly or broken skin
• Crusts, scabs, or cuts in the skin
• Bleeding
• Drainage or pus
• Warmth or heat at the affected area

Scars

• Pain, itching, or discomfort (especially during early healing; can also restrict movement)
• Texture changes (may be smooth, raised, or indented)
• Color changes (often lighter or darker than the surrounding, unaffected skin)

Treatments for wounds

There are many types of treatments available for wound care. The treatment you need will depend on the cause, type, location, and severity of your wound.

These are some of the most common wound treatments used for people with cancer:

Antibiotics

If you have a wound along with a fever or other signs of infection, antibiotics or other antimicrobial medications might be used.

Wound debridement

Infected wounds or dead tissue might need to be removed so the wound can heal. This is called wound debridement. Debridement can be done with irrigation (using fluids such as sterile water or saline to flush the wound with low pressure), surgically with a tool, or with special enzymes.

Wound packing

Deep wounds with open areas are often packed with special materials or dressings to help wound healing and prevent infection.

Topical therapies

Special treatments that contain growth factors, antibiotics, antimicrobials, iodine, silver, or other therapies can be put on the wound itself. These can help the wound heal and prevent infection or other problems.

Dressings

Dressings are often applied to wounds after they are cleaned, debrided, or packed. This helps improve healing, prevent infection, and protect the wound. Dressings can be wet or dry depending on the type of wound. Wound dressings are commonly made from materials like foam, hydrogels, hydrocolloids, honey, iodine, silicone, and silver.

Negative pressure wound therapy

Negative pressure wound therapy (often known as a wound vacuum device) is sometimes used after surgery. It is also used for some large, nonhealing wounds.

Oxygen therapy

Some studies have shown oxygen therapy, such as hyperbaric oxygen therapy (HBOT), may be helpful when used with other treatments for wounds. Large or nonhealing wounds, as well as surgical flaps or grafts, might benefit from HBOT.

Treatments for scars

Scar treatment depends on your symptoms. It also depends on the type and severity of the scar. You might get one or more of these common treatments:

• Corticosteroid tape or plaster (a special tape cut to match your scar’s shape)
• Corticosteroid injections or ointments
• Compression therapy with special garments or devices
• Gel sheets made of silicone or non-silicone to keep scars moisturized and reduce tightness and tension
• Laser therapy for scar redness and itchiness
• Cryotherapy to reduce scar size
• Certain types of chemo injected into scar tissue to reduce scar formation and tension
• Surgical scar removal

Tips for managing wounds and preventing scars

You can take these steps to manage your wounds and help prevent or minimize scars:

Keep the wound clean. Infected wounds are more likely to cause worse scarring.

• If you have a new wound from an accidental injury, wash it with soap and warm water.
• If you have an existing wound, clean it once a day with soap and water unless you were given different instructions by your health care team.
• Wash your hands well before and after changing a dressing or bandage. Use gloves if instructed.
• Never re-use dressings. Ask what types of dressings and supplies are okay to use with your wound.
• Keep your dressing clean and dry. If it gets wet or dirty, change it right away.
• If you have any prescribed medications, like antibiotics, take them as directed and finish the full prescription.
• Avoid baths and swimming while your wound is still healing.

Prevent excessive bleeding and further injury while the wound heals. This can increase your risk of scarring.

• If the wound is bleeding, clean it well and apply moderate pressure with a cool cloth or ice pack until the bleeding stops. Then continue with the dressing change.
• Try not to put tape right onto your skin. Apply a skin prep solution first, then tape over top. Or, wrap gauze over the bandage and then tape the gauze.
• Check with your nurse or pharmacist about supplies.
• Avoid scratching or rubbing the wound. Don’t remove scabs.
• Protect wounds and scars from the sun and ultraviolet (UV) radiation, especially before they are fully healed. Ask if it’s okay to apply sunscreen to the area.

Promote wound healing. Good health and nutrition can help.

• Unless you’re told otherwise, keep the area moisturized. Use a hypoallergenic, cream-based moisturizer such as Vanicream, Aveeno, CeraVe, or Eucerin.
• Avoid irritating the area as it heals. Avoid tight clothing, very hot water, and products with strong perfumes or chemicals.
• Eat citrus fruits, green leafy vegetables, whole grains, meat, fish, and eggs. These foods contain protein, vitamins, and minerals that are important for wound healing.

When to talk to your doctor or cancer care team

Let your doctor or cancer care team know if you have:

•  A new wound
•  Wound bleeding that lasts for a long time or doesn't stop when pressure is applied
• A wound that looks very red around the edges and is hot or swollen
• More pain than usual at the wound site
• A bad smell coming from the wound
• Yellow pus or greenish liquid that oozes from the wound
• Signs or symptoms of infection without a known cause