Hypertrophic scarring

A 30-year old woman saw a consultant dermatologist member of the MDU because of concerns about the appearance of a mole on her chest. There were no features suggestive of malignancy but the patient was self-conscious about it and asked about the possibility of having it removed.

The dermatologist discussed the procedure with the patient, and then excised the mole. Histology confirmed that it was benign. The patient was reviewed 10 days later and the sutures were removed. At a further review appointment a week later, the wound was healing well and the patient was discharged. She was advised to contact the dermatologist again should any problems arise.

Six months later, the patient re-attended, saying she was concerned about the appearance of the scar. The MDU member noted that there was hypertrophic scarring of the wound, and excised the scarring, but several months later the patient sought a second opinion because of ongoing concerns about the scar's appearance.

A year after the MDU member last saw the patient, he received a request for copies of the medical records, which the MDU disclosed on his behalf. This was followed several months later by a letter of claim. It was alleged that the dermatologist had not explained the risk of hypertrophic scar formation before removing the mole. It was also alleged that when the claimant re-attended with concerns about the scarring, she should have been offered intra-lesional steroid injections, rather than scar revision which carried a risk of further hypertrophic scarring.

The mole removal was purely for cosmetic purposes, and surgery on the chest area carries a significant risk of hypertrophic scarring.

The MDU obtained detailed comments from the member on the consent process. He confirmed that the claimant had been warned of the risk of scarring following removal of the mole, but not specifically of the risk of hypertrophic scar formation.

An independent dermatologist provided expert evidence on the case. He observed that the mole removal was purely for cosmetic purposes, and surgery on the chest area carries a significant risk of hypertrophic scarring. Given this, the claimant should have been specifically warned of the risk of hypertrophic scar formation. Once hypertrophic scarring had occurred, the expert agreed with the letter of claim, that the MDU member should have offered a reasonable trial of treatment with intra-lesional steroid injections, and the failure to do so was a breach of duty of care. Treatment with intra-lesional steroid injections would probably have improved the appearance of the scar, whereas scar revision was very likely to result in recurrence of the hypertrophic scarring.

Following receipt of this report, the MDU member's comments were sought, and with his agreement the MDU settled the claim for £4,000 in damages, and also paid the claimant's solicitor's fees of £13,000.

Dr Claire Wratten
Senior medical claims handler

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