Tori attended her GP Surgery in 2014 after noticing some changes in the pigmented birth marks on her chest and arm. She was referred to dermatology and advised she had an epidermal nevus on her chest wall and the inner aspect of her left arm. An epidermal nevus is a family of skin lesions that involve the epidermis (the outer layer of the skin). They are caused by an overgrowth of cells. If the nevus does not originate too deeply, they can be surgically removed. As Tori was only in her early 20s and felt that her birth mark was very obvious, she opted to have it treated.
Tori was referred for a combination of laser therapy and surgery to treat the marks and placed on a waiting list. She was eventually seen by a consultant plastic surgeon who informed Tori of some of the risks involved. Listed on the consent form included possible risks such as infection, bleeding, scarring, and reoccurrence.
Three months after her surgery, Tori noticed that the scar was tight and returned to the hospital for a follow-up appointment to express her concerns. The hospital noted some hypertrophy – an increase in volume of the scar tissue due to the enlargement of component cells. The doctor informed Tori not to worry and that her scar would improve over time.
After another three months, Tori returned to the hospital and expressed her disappointment with the hypertrophic scar and poor result of her surgery. She was advised that scarring was an unpredictable element of surgery but that it would be worth performing a further excision to remove the heavily scarred area and see if that helped.
This second excision was performed over a year later. This time, the consent form noted hypertrophic scarring and further surgery as possible risks. Given Tori’s skin type and age, she was a likely candidate for further hypertrophic scarring and unfortunately, she was left with a large scar that was much worse and more obvious than it had been before surgery. Tori was devastated to have been left with scaring that was far worse than her original birth mark.
An expert advised Pryers that Tori should have been given pressure garments and a series of steroid injections into the scar following her reports of tightening after the first surgery. This would have avoided an unnecessary second procedure and possibly led to a better cosmetic outcome.
Having come to terms with the scarring, Tori is now 20 years old and has been able to move on with her life. She is currently serving active duty in the Army.