Ann Dermatol.  2016 Oct;28(5):615-623. 10.5021/ad.2016.28.5.615.

Values of a Patient and Observer Scar Assessment Scale to Evaluate the Facial Skin Graft Scar

Affiliations
  • 1Department of Dermatology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea.
  • 2Department of Beauty Design, Wonkwang University, Iksan, Korea. jh@wku.ac.kr

Abstract

BACKGROUND
The patient and observer scar assessment scale (POSAS) recently emerged as a promising method, reflecting both observer's and patient's opinions in evaluating scar. This tool was shown to be consistent and reliable in burn scar assessment, but it has not been tested in the setting of skin graft scar in skin cancer patients.
OBJECTIVE
To evaluate facial skin graft scar applied to POSAS and to compare with objective scar assessment tools.
METHODS
Twenty three patients, who diagnosed with facial cutaneous malignancy and transplanted skin after Mohs micrographic surgery, were recruited. Observer assessment was performed by three independent rates using the observer component of the POSAS and Vancouver scar scale (VSS). Patient self-assessment was performed using the patient component of the POSAS. To quantify scar color and scar thickness more objectively, spectrophotometer and ultrasonography was applied.
RESULTS
Inter-observer reliability was substantial with both VSS and the observer component of the POSAS (average measure intraclass coefficient correlation, 0.76 and 0.80, respectively). The observer component consistently showed significant correlations with patients' ratings for the parameters of the POSAS (all p-values<0.05). The correlation between subjective assessment using POSAS and objective assessment using spectrophotometer and ultrasonography showed low relationship.
CONCLUSION
In facial skin graft scar assessment in skin cancer patients, the POSAS showed acceptable inter-observer reliability. This tool was more comprehensive and had higher correlation with patient's opinion.

Keyword

Cicatrix; Patient and observer scar assessment scale; Skin graft

MeSH Terms

Burns
Cicatrix*
Humans
Methods
Mohs Surgery
Self-Assessment
Skin Neoplasms
Skin*
Transplants*
Ultrasonography

Figure

  • Fig. 1 Clinical images of skin graft scar. (A) A 73-year-old woman who underwent skin graft because of basal cell carcinoma on the ala of nose. Evaluating skin graft scar using patient and observer scar assessment scale (POSAS) 17 months later, patient scar score was 13 and the mean observer scar score was 8.6. The patient score of POSAS: pain (2), itchiness (3), color (2), stiffness (2), thickness (2), irregularity (2). The mean observer score of POSAS: vascularity (1.3), pigmentation (1.3), thickness (2.0), relief (1.0), pliability (1.3), surface area (1.3). (B) The patient score of skin graft scar who had Moh's micrographic surgery on dorsum of nose 1 year ago was 22. The observer score was 15.3. The patient score of POSAS: pain (1), itchiness (1), color (5), stiffness (5), thickness (5), irregularity (2). The mean observer score of POSAS: vascularity (1.7), pigmentation (3.0), thickness (3.0), relief (2.3), pliability (3.3), surface area (2.0) (presented with permission patients). Preop: preoperative, postop: postoperative.

  • Fig. 2 The correlation between patient and observer scar assessment scale (POSAS) to objective scar assessment tool. (A) a* indicated color values from green to red and it was applied to scar vascularity. The correlation between POSAS and spectrometer was significant but moderate relationship. (B, C) L* expressed brightness and it was used for the evaluation of scar pigmentation. b* designated values from blue to yellow and it was used for the measurement of scar pigmentation along with L*. The degree of correlation about pigmentation showed insignificant results between two different scar evaluation tool. (D) The correlation between POSAS and objective assessment using ultrasonography showed low relationship.


Cited by  1 articles

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Joo-Hak Kim, Chang Hwan Ahn, Sungmin Kim, Young Lee, Sang-Ha Oh
Ann Dermatol. 2019;31(1):1-5.    doi: 10.5021/ad.2019.31.1.1.


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