POSAS & Vancouver scar scales
POSAS · Vancouver Scar Scale (VSS) · scar outcome instruments
The Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS) are the two most widely-validated scar-outcome instruments. POSAS captures both patient and clinician perspectives and is recommended by UK BAPRAS, NICE technology appraisals and outcome-research frameworks. VSS is older and clinician-only but remains in widespread use. Both inform research, audit, clinical trials of biological / laser / topical interventions and provide structured documentation for medico-legal and reconstructive practice.
POSAS (Patient and Observer Scar Assessment Scale)
- Developed by van der Wal / Draaijers et al, 2004; updated to POSAS 2.0 (≈2005) and POSAS 3.0 (2022).
- Two parallel components: Patient Scale and Observer Scale; each scores six items 1-10.
- Observer Scale items: vascularity, pigmentation, thickness, relief, pliability, surface area + overall opinion.
- Patient Scale items: pain, itch, colour, stiffness, thickness, irregularity + overall opinion.
- Each item: 1 (like normal skin) → 10 (worst scar imaginable). Total each scale 6-60.
- POSAS 3.0 (2022) refined wording and includes 8 patient items.
Strengths: dual-perspective (clinician + patient), validated multiple languages, sensitive to change.
Use-cases: research outcome, clinical-trial endpoint, surgical audit, structured follow-up of complex reconstruction.
Vancouver Scar Scale (VSS)
- Developed by Sullivan et al, 1990 (originally for burn scars).
- Four items, clinician-only:
- Vascularity: normal (0) / pink (1) / red (2) / purple (3).
- Pigmentation: normal (0) / hypopigmented (1) / hyperpigmented (2).
- Pliability: normal (0) / supple (1) / yielding (2) / firm (3) / banding (4) / contracture (5).
- Height: flat (0) / <2 mm (1) / 2-5 mm (2) / >5 mm (3).
- Total 0-13.
Strengths: simple, quick.
Limitations: no patient input; subjective vascularity score; less sensitive than POSAS; insensitive to small but meaningful change.
Other instruments
- Manchester Scar Scale — additional items including contour, distortion.
- Stony Brook Scar Evaluation Scale — 5-item; quick post-op assessment.
- Scar Cosmesis Assessment and Rating (SCAR) scale — 6-item.
- Patient-reported scar outcome measures: BSHS-B, SCAR-Q (specifically designed for surgical scar PROMs, McGill / BAPRAS endorsed).
- 3D imaging / objective measurement: Cutometer (elasticity), DermaScan (thickness ultrasound), Visia / 3D Vectra (volumetric).
Practical use in skin oncology
- Record baseline POSAS at 3 months and 12 months post-op for major reconstruction (Mohs nose, flap revision, lymphadenectomy scar).
- Combine with photography; orient camera, lighting and distance reproducibly.
- Use as audit metric for surgical / laser / biological-treatment outcomes.
- Include in MDT documentation for patients in clinical trials.
- Document patient-reported items honestly — body image and itch / pain are commonly under-recognised by clinicians.
- POSAS 3.0 is open-access at posas.org; reference correctly in publications / audits.
References
- Draaijers LJ et al. The Patient and Observer Scar Assessment Scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113:1960-1965.
- van de Kar AL et al. Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plast Reconstr Surg. 2005;116:514-522.
- Sullivan T et al. Rating the burn scar. J Burn Care Rehabil. 1990;11:256-260.
- Klassen AF et al. Development and validation of the SCAR-Q: a new patient-reported outcome measure for evaluating surgical and traumatic scars. BMJ Open. 2018;8:e025305.
- POSAS Steering Committee. POSAS 3.0. Available at: www.posas.org. Accessed 2026.
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