Americans spend more than $12 billion per year on cosmetic procedures to enhance their appearance, whether it’s tanning, implanting, nipping or tucking. That’s because physical appearance influences nearly every aspect of our lives. And it’s not all our own insecurities or judgments, either. Studies show that strangers who observe photographs of people with facial abnormalities are more likely to judge them as dishonest, unsuitable for employment, unintelligent and unattractive.

A recent literature review from dermatologic surgeons at the Perelman School of Medicine at the University of Pennsylvania, including Joseph F. Sobanko, MD, director of Dermatologic Surgery Education, and an assistant professor of Dermatology at the Hospital of the University of Pennsylvania, and David Sarwer, PhD, Professor of psychology in Psychiatry and Surgery, highlights just how influential facial asymmetries, such as scars resulting from skin cancer surgeries, can be on our psychosocial well-being. And, just like no one is exempt from the dangers of skin cancer, no one is exempt from feeling the impact of a scar either; the psychosocial impact of scarring from the treatment of facial skin cancers has been shown to affect the young, old, male and female alike.

So for patients with scars, how they feel about themselves and how they handle social situations may be heavily dependent on the final aesthetic outcome of surgery.

At Penn Medicine, skin cancer and reconstructive surgeons use advanced surgical techniques to help individuals restore form and function, as well as feel good about their appearance. The Mohs technique, which is a micrographic form of skin cancer removal in highly functional and cosmetically sensitive areas such as the face and hands, maps out the cancer and removes the smallest amount of normal skin surrounding the tumor. This results in smaller defects that need to be repaired and subsequently smaller scars from the surgery. Additionally, the meticulous reconstruction of skin by Penn doctors, tailored to each patient’s particular profile, can result in virtually unnoticeable scars.

The study from Sobanko and colleagues reveals that better cosmetic results from surgery translates into patients with higher levels of satisfaction.

“Thirteen percent of cancer survivors quit work for cancer-related reasons, and of those, patients with head and neck cancer have the highest risk for going on medical disability because of the psychosocial burden of dysfunction and disfigurement,” Sobanko said. “What we’re learning now is that these scars are much more than skin deep, and given these possible repercussions, it’s vital that surgeons be able to provide patients with advanced treatment options to limit and avoid visible scarring.”

With an ever increasing number of skin cancer surgeries being performed in the United States, Sobanko says the study provides suggestions not only for techniques that could drastically improve quality of life for these patients, but also for the identification and management of patients at risk for psychosocial impairment from scarring.

“Skin cancer can be a scary diagnosis for patients, whether it’s melanoma, basal cell, or squamous cell carcinoma," Sobanko said. "These tumors occur in highly visible areas and may create psychosocial distress."

Recently, Dr. Sobanko received a career development award from the Dermatology Foundation to further research related to patient appearance and quality of life. His team’s research is moving in a direction that measures patient health-related quality of life, highlights the emotional burden of changes that accompany oncologic, reconstructive, and aesthetic treatments, and also illustrates that we can restore patients’ appearances to allow them to go back to living the way they want to – with sunscreen, of course. 

“We also want to create predictive models to identify who will be most impacted by their skin cancer in order to precisely target those patients who will benefit from enhanced perioperative counseling and education,” he said.