Subject(s)
MART-1 Antigen/analysis , Melanoma/surgery , Neoplasm Recurrence, Local , Skin Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Immunohistochemistry , Male , Margins of Excision , Melanoma/chemistry , Melanoma/pathology , Middle Aged , Mohs Surgery , Neoplasm Invasiveness , Neoplasm Recurrence, Local/pathology , Neoplasm, Residual/chemistry , Retrospective Studies , Skin Neoplasms/chemistry , Skin Neoplasms/pathology , Young AdultSubject(s)
Immunocompromised Host , Medical Overuse/statistics & numerical data , Mohs Surgery/statistics & numerical data , Procedures and Techniques Utilization/statistics & numerical data , Publishing , Skin Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND: Changes in patient perceptions of quality of life (QOL) after Mohs micrographic surgery (MMS) may benefit from different counseling or treatment. OBJECTIVE: To measure QOL before and after MMS and to identify risk factors associated with impaired QOL. METHODS: Prospective observational study of 727 patients with skin cancer who self-reported QOL via the Skin Cancer Index immediately before and at 1 to 2 weeks and 3 months after MMS. RESULTS: QOL fluctuated after MMS. At 1 to 2 weeks after surgery, overall QOL remained unchanged compared with before MMS. Patients reported reduced anxiety about skin cancer but had increased distress about social interactions and physical appearance. At 3 months after surgery, patients reported an overall improvement in QOL compared with before MMS (P = .0007). Age younger than 65 years (P = .0001), female sex (P = .0001), and tobacco use (P = .03) were associated with lower QOL scores at all assessment points. LIMITATIONS: Single-site observational study. Significant loss to follow-up at both time points after MMS. CONCLUSION: Patients with skin cancer had persistent concerns about social interactions and physical appearance 1 to 2 weeks after MMS, but all aspects of their QOL improved by 3 months after surgery. Patients who underwent MMS that were younger than 65 years, were female, or smoked were at increased risk for longitudinally impaired QOL.
Subject(s)
Anxiety/psychology , Body Image/psychology , Mohs Surgery/psychology , Quality of Life , Skin Neoplasms/surgery , Aged , Esthetics , Female , Humans , Interpersonal Relations , Longitudinal Studies , Male , Middle Aged , Mohs Surgery/methods , Patient Reported Outcome Measures , Perioperative Care , Prospective Studies , Skin Neoplasms/pathology , Skin Neoplasms/psychology , Statistics, Nonparametric , Time FactorsABSTRACT
IMPORTANCE: Surgical scarring affects patients by distracting the gaze of onlookers, disrupting social interactions, and impairing psychosocial health. Patient and physician agreement regarding ideal scar characteristics is important in developing congruent expectations after surgery. OBJECTIVE: To summarize published studies assessing patient and physician ratings of surgical scars, rates of patient and physician agreement in scar assessment, and elements of cutaneous scar assessment that differ between patients and physicians. EVIDENCE REVIEW: A literature search of Ovid/Medline, PubMed, and EMBASE was conducted from January 1, 1972, to August 1, 2015. Prospective studies comparing scars from different surgical techniques using at least 1 physician-reported and patient-reported scar measure were included. Strength of studies was graded according to the Oxford Centre for Evidence-Based Medicine guidelines. FINDINGS: The review identified 29 studies comprising 4485 patients. Of the 29 included studies, 20 (69%) were randomized clinical trials (RCTs), 5 (17%) were prospective, nonrandomized studies, and 4 (14%) were descriptive studies. Disagreement between patients and physician evaluation of scars occurred in 28% (8 of 29) studies, with only patients rating scar difference in 75% (6 of 8) of these cases. Patients were more likely to value scar depth while physicians were more likely to value scar pigmentation and relief. CONCLUSIONS AND RELEVANCE: Methodologically rigorous studies that include clinician- and patient-reported scar outcomes are uncommon. Studies that incorporate subjective and objective scar grading reveal disagreement between patients and clinicians. Of the incision and wound closure techniques assessed, few affected patient- and clinician-reported outcomes, but the evidence remains weak and future studies are recommended.
