Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science


Health and Rehabilitation Sciences


Doyle, Philip C.

2nd Supervisor

Moore, Corey C



Facial skin cancer secondary to surgical treatment may be distressing due to the malignancy itself and from the consequences of its treatment. A visible postsurgical scar is an obvious reminder of the condition. This investigation sought to broaden our understanding of facial scarring and develop a novel tool for its objective evaluation. To this end, skin cancer as the most common etiology of facial scarring was reviewed. The scar scale literature was evaluated in the context of assessing scars through a biopsychosocial lens. Finally, the development of a novel scar scale was presented. Thirty-four individuals completed 13,056 ratings using a novel scar scale – the Scar Camouflage Scale (SCS). Preliminary data demonstrated intra-rater agreement of 0.74 - 0.92 and between-rater agreement of 0.78 - 0.96. In conclusion, through rigorous methodology this investigation provides preliminary support for the establishment and use of the Scar Camouflage Scale (SCS). These results provide the empiric basis for wholistic scar evaluation.

Summary for Lay Audience

Facial skin cancer is an anxiety provoking condition. Not only is the diagnosis distressing, but so too is the consequence of its treatment which is most commonly surgery. Regardless of location, every surgery will result in some form of scaring. When this affects the face, scarring is a visible daily reminder of the condition, one that may also impact one’s physical appearance and body image.

Many factors contribute to how a scar impacts an individual’s body image. However, few research studies have been able to holistically understand these factors, or determine how the scar itself contributes to the person’s overall body image and self-perception. One of the main difficulties lies in the way scars are currently evaluated. The research conducted has been somewhat inconsistent and we remain without a standardized way to measure scars.

This investigation sought to improve our understanding of facial scarring and develop a new scar measurement tool. To achieve these goals, we reviewed the most common reason that an individual might acquire a facial scar – facial skin cancer. We then assessed how scars affect a person relative to their psychological and social impact. To this end, we reviewed all relevant literature and aimed to place these in the context of what is termed the “biopsychosocial” model of health. Finally, we presented the results of a study that sought to develop a new scar scale called the Scar Camouflage Scale (SCS).

The results of this study demonstrate that individuals can reliably measure scars using the SCS, even when different individuals measure the same scar. These data provide the necessary evidence to support further research using the SCS and apply this research to help understand the comprehensive impact of facial scaring.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.