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Case Study:
Basal Cell Carcinoma Post-Surgical Scar
Click the QR to see PCCA PracaSil™-Plus more PCCA studies and reports. Abstract: Basal cell carcinoma is a type of skin cancer that often leads to surgical excision of the affected area, which results in
destruction of the tissues and skin scarring. The purpose of this case study is to discuss the management of a basal cell carcinoma post-
surgical scar using PracaSil-Plus in a 41-year-old Caucasian male. The POSAS Patient Scale (adapted) was the research instrument
used to evaluate the efficacy of PracaSil-Plus in scar management therapy. Following PracaSil-Plus treatment, the total POSAS score
decreased by 33 and the patient's overall opinion by 6, corresponding to improvements of 76.7% and 75.0%, respectively. The post-
treatment scar was no longer painful or itchy and all other parameters (color, stiffness, thickness and irregularity) were very similar to
normal skin, which demonstrates a successful recovery process and a considerable improvement in the patient's quality of life.
management therapy. The POSAS Patient Scale is a Basal cell carcinoma (BCC) is a type of skin cancer validated scar assessment instrument designed for a that arises from the uncontrolled growth of basal cells subjective evaluation of various types of scars directly by lining the deepest layer of the epidermis. There is a high the patients. It is commonly used in clinical practice as it incidence of BCC as over 2 million people are estimated has shown good internal consistency, reliability and to be diagnosed with BCC every year in the United agreement. The POSAS Patient Scale contains seven States, with a higher prevalence in the Caucasian items that are scored numerically on a Likert scale from population [1, 2]. The etiology of BCC is usually 1 (normal skin) to 10 (worst scar). The first six items associated with exposure to ultraviolet radiation in refer to the following scar parameters: pain and itching sunlight. Following diagnosis, surgical excision of the (scar sensation); color; stiffness; thickness and cancerous cells is the most common treatment option irregularity (scar appearance). The last parameter rates [2]. Surgical excision can result in destruction of the the patient's overall opinion of the scar when compared tissues, leading to scarring and disfigurement. to normal skin. The numerical rating is obtained by Unfortunately, scars cannot yet be made to disappear, adding the scores of the six parameters (range 6 to 60), and may range from a desirable fine line to a variety of in addition to the overall score (range 1 to 10). The abnormal scars, including hypertrophic and keloid scars. higher the scores obtained, the worse the scar quality Taking into account that clinical treatments do not entirely eliminate skin scarring, the therapeutic goal is to The patient was asked to complete the POSAS reduce, as much as possible, the severity of the scars Patient Scale retrospectively by rating his basal cell carcinoma post-surgical scar, before and after treatment The purpose of this case study is to discuss the with PracaSil-Plus. Written informed consent was management of a basal cell carcinoma post-surgical obtained from the patient for publication of this case scar using PracaSil-Plus, a topical silicone base study and the accompanying digital images. containing Pracaxi oil, used alone or in combination with active pharmaceutical ingredients in scar management Results and Discussion:
The patient completed all parameters of the POSAS adapted scale, as displayed in Table 1. The patient also shared the digital images of the affected area, before A 41-year-old Caucasian male with no significant and after treatment with PracaSil-Plus (Figures 1-3). underlying medical conditions was diagnosed with basal Before treatment with PracaSil-Plus, the total score cell carcinoma, presented as a solitary patch at the tip of of the first six items was 43 which suggests a poor his nose. Following diagnosis, tumor cells were removed quality scar, very different from normal skin. For with surgical excision of the affected area. Graft skin was sensation, the patient rated the scar to be painful (n=8) taken from the patient's forehead to patch the tip of his and itchy (n=7). For appearance, higher (worst) scores nose. The patient was then instructed by his physician to were obtained for scar color (n=9) and stiffness (n=9), use Bactroban™ ointment for 5 days until the wound whereas lower scores were obtained for scar thickness closed. Following wound closure, the patient was (n=4) and irregularity (n=6). The overall opinion was instructed to apply PracaSil-Plus to the affected area, rated 8 (range 1 to 10) which also suggests a poor one to two times a day. The patient was asked to obtain quality scar, very different from normal skin. standardized digital images of the affected area before After treatment with PracaSil-Plus, the total score of and after treatment with PracaSil-Plus. the first six items was 10 (range 6 to 60) which suggests The Patient and Observer Scar Assessment Scale a very good quality scar. The total score decreased by (POSAS) v2.0/EN, in particular the POSAS Patient 33, from 43 (pre-treatment) to 10 (post-treatment), Scale (adapted), was the research instrument used to corresponding to an improvement of 76.7% in relation to evaluate the efficacy of PracaSil-Plus in scar scar sensation and appearance. 2015 PCCA Science 98943 1 of 2

Case Study:
Basal Cell Carcinoma Post-Surgical Scar
PCCA PracaSil™-Plus
Figure 1. Digital image of post-surgical
Figure 2. Digital image of scar 2 months
Figure 3. Digital image of scar 11 months
scar before treatment with PracaSil-Plus. post-treatment with PracaSil-Plus. post-surgery. The scar was no longer painful (n=1) or itchy (n=1) irregularity), indicating significant improvements in scar and all other parameters (color, stiffness, thickness and quality following PracaSil-Plus treatment. The highest irregularity) were very similar to normal skin (n=2). The improvements were noticed in pain (87.5%) and itching patient's overall opinion decreased by 6, from 8 (pre- (85.7%), which are the parameters that are likely to treatment) to 2 (post-treatment), corresponding to an have the greatest impact on the patient's quality of life. overall improvement of 75.0%, as displayed in Table 1. The total POSAS score and the patient's overall opinion also showed considerable improvements in scar quality Table 1. POSAS parameters and corresponding patient's scores,
(76.7% and 75.0%, respectively). The patient rated his before and after treatment with PracaSil-Plus. basal cell carcinoma post-treatment scar as very similar Score (n) Score (n) to normal skin (n=2), which demonstrates a successful Parameters
recovery process and a considerable improvement in the patient's quality of life. PracaSil-Plus may then be recommended by compounding pharmacists as the treatment of choice in scar management therapy. Stiffness References:
1. Fung K, Suhail M, McClendon B, Woolley C, Young D, Lin H. Thickness Management of basal cell carcinoma of the skin using Irregularity frankincense (boswellia sacra) essential oil: a case report. OA Alternative Medicine 2013; 1 (2): 1-5. 2. Jadotte Y, Sarkissian N, Kadire H, Lambert W. Case report: superficial spreading basal cell carcinoma of the face: a Overall opinion
surgical challenge. Open Access Journal of Plastic Surgery 2010; 10: 394-8. 3. Bayat A, McGrouther D, Ferguson M. Skin scarring. BMJ 2003; Skin scarring is often considered trivial but may also 4. Bayat A, McGrouther D. Spectrum of abnormal skin scars and be aesthetically unpleasant and disfiguring, causing their clinical management. Br J Hosp Med 2006; 67 (10): 527- distress, anxiety and other psychosocial consequences. Scars may also have physical consequences such as 5. Brown B, Moss T, McGrouther D, Bayat A. Skin scar pre- tenderness, itching and pain, which are functionally conceptions must be challenged: Importance of self-perception disabling and can contribute to diminished quality of life in skin scarring. Journal of Plastic, Reconstructive & Aesthetic Surgery 2010; 63 (6): 1022-9. [3-6]. Scar management therapy is therefore an 6. Banov D, Banov F, Bassani A. Case series: the essential component in the post-surgical recovery effectiveness of fatty acids from pracaxi oil in a topical silicone base for scar and wound therapy. Dermatol Ther 2014; 4 (2): This case study has demonstrated that PracaSil- Plus, a topical silicone base containing Pracaxi oil, is 7. van de Kar A, Corion L, Smeulders M, Draaijers L, van der Horst C, van Zuijlen P. Reliable and feasible evaluation of effective in scar management therapy. The POSAS linear scars by the patient and observer scar assessment patient scores showed a significant reduction of all scar scale. Plastic and Reconstructive Surgery 2005; 116 (2): 514- parameters, from scar sensation (pain and itching) to scar appearance (color, stiffness, thickness and 2015 PCCA Science 98943 2 of 2

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