Timing of Suture Removal to Reduce Scarring in Skin Surgery

This is a single centre prospective randomized assessor blinded parallel group feasibility study that will be undertaken in the Royal Devon and Exeter Dermatology department. The investigators will be looking at whether timing of percutaneous suture removal after skin surgery impacts on the incidence of suture marks and overall scar cosmesis.

Stitch marks (also known as suture marks or track marks) are permanent marks left in the skin where the stitch has caused local tissue damage and scarring. The risk of these marks is in part thought to be related to the length of time that the stitches are left in place before removal. Stitches are normally left in place for longer on sites where the skin is under greater tension such as the chest or back because there is a concern that the wound may be more likely to open up on these sites. On the chest or back, stitches may be left in place for up to 14 days even though the chest or back is a common site for stitch marks to form. The investigators are conducting a single centre prospective randomized assessor blinded parallel group feasibility study to estimate a sample size required for a properly powered RCT, and also to provide some preliminary data on the incidence of wound complications and overall scar cosmesis in each group. All patients attending the dermatology department for wide local excision as part of their skin cancer treatment and primary closure of the subsequent wound will be considered for entry into the trial. Clinicians will identify potential participants during routine practice at their clinic visit. Patients who fulfil the entry criteria will be invited at that appointment to take part. On the date of participants skin surgery, they will be consented and randomized to either 'suture removal at 7 days' or 'suture removal at 10 days'. Participants will then be booked for a 3 month follow up where the scar site will be evaluated from a patient and clinician perspective to assess suture marks and overall cosmesis.

In patients undergoing wide local excision and primary wound closure for treatment of skin cancer does earlier removal of percutaneous sutures (7 days rather than 10 days) reduce the incidence of suture marks assessed at 3 months post-operatively.

Does earlier suture removal have an impact (negative or positive) on overall scar cosmesis and wound complication rates (as assessed by the clinician and the patient)?

Inclusion Criteria: Patients of 18 years old or above who had capacity to consent to surgery who were willing to attend follow-up appointments within the department Patients undergoing wide local excision as part of their skin cancer treatment pathway Lesions excised from the anterior chest or back Post-operative wound >/= 10mm width Wound could be closed with primary intention healing Exclusion Criteria: Inability to provide valid informed consent and/or unwilling to attend for follow-up Wounds where the edges could not be closely adhered with dermal sutures alone. Wounds requiring a flap or graft for closure. Patients requiring further treatment following original excision eg. Further WLE, radiotherapy etc.

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