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Baxi S, Vohra S, Hong A, Mulholland N, Heuschkel M, Dahlhoff G, Cardaci G, Mirzaei S, Sathekge M. Effectiveness and Patient Experiences of Rhenium Skin Cancer Therapy for Nonmelanoma Skin Cancer: Interim Results from the EPIC-Skin Study. J Nucl Med 2024; 65:1450-1455. [PMID: 39025650 DOI: 10.2967/jnumed.124.267988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
Nonmelanoma skin cancer and its treatment represent a significant global cancer burden for health care systems and patients. Rhenium skin cancer therapy (Rhenium SCT) is a novel noninvasive radionuclide nonmelanoma skin cancer treatment, which can be provided in a single outpatient session. The aim of this prospective, multicenter, single-arm, international, phase IV study (EPIC-Skin) is to assess clinic- and patient-reported outcomes of Rhenium SCT as a treatment for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods: Eligible patients had biopsy-proven stage I or stage II BCC or SCC lesions no more than 3 mm deep and no larger than 8 cm2 in area. Rhenium SCT resin was applied to an adhesive foil affixed to the target lesion in a single session. Interim efficacy and safety analysis were planned once 50% of target patients had recorded a 6-mo follow-up visit. Primary outcome is the proportion of lesions achieving complete response using modified RECIST. Secondary and other outcome measures include patient-reported quality of life (QoL), treatment comfort, and cosmesis. Results: A total of 182 patients was enrolled and administered Rhenium SCT (50 Gy dose to deepest point of target) to at least 1 BCC or SCC. Of 81 patients who reached the 6-mo posttreatment follow-up, it was found that 97.2% (103/106) of lesions showed complete responses and 2.8% (3/106) had partial responses. Improvements in QoL were also reported, whereas no patients reported any pain or discomfort during treatment. Adverse events were reported in 15.9% (29/182) of patients and were rated grade 1 (n = 19), grade 2 (n = 9), or grade 3 (n = 1). Conclusion: This preliminary analysis of the EPIC-Skin study indicates that Rhenium SCT is safe and effective for the treatment of BCC and SCC and is associated with significant QoL improvements. It will be particularly beneficial for lesions that are difficult to treat surgically because of size and location. It is also beneficial for patients with comorbidities or those unable to receive conventional fractionated radiotherapy.
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Affiliation(s)
- Siddhartha Baxi
- Genesis Cancer Care, John Flynn Hospital, Tugun, Queensland, Australia
| | - Saima Vohra
- Avion Medical Skin Centres, North Melbourne, Victoria, Australia
| | - Angela Hong
- Genesis Cancer Care, North Shore Health Hub, St. Leonards, New South Wales, Australia
- Melanoma Institute Australia, Poche Centre, Crows Nest, New South Wales, Australia
| | - Nicola Mulholland
- Department of Nuclear Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Martin Heuschkel
- Department of Nuclear Medicine, University Medical Center Rostock, Rostock, Germany
| | | | - Giuseppe Cardaci
- Department of Nuclear Imaging, Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Siroos Mirzaei
- Clinic Ottakring, Institute of Nuclear Medicine with PET Center, Vienna, Austria; and
| | - Mike Sathekge
- Department of Nuclear Medicine, Steve Biko Academic Hospital, Pretoria, South Africa
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Gumilar KE, Indraprasta BR, Hsu YC, Yu ZY, Chen H, Irawan B, Tambunan Z, Wibowo BM, Nugroho H, Tjokroprawiro BA, Dachlan EG, Mulawardhana P, Rahestyningtyas E, Pramuditya H, Putra VGE, Waluyo ST, Tan NR, Folarin R, Ibrahim IH, Lin CH, Hung TY, Lu TF, Chen YF, Shih YH, Wang SJ, Huang J, Yates CC, Lu CH, Liao LN, Tan M. Disparities in medical recommendations from AI-based chatbots across different countries/regions. Sci Rep 2024; 14:17052. [PMID: 39048640 PMCID: PMC11269683 DOI: 10.1038/s41598-024-67689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
This study explores disparities and opportunities in healthcare information provided by AI chatbots. We focused on recommendations for adjuvant therapy in endometrial cancer, analyzing responses across four regions (Indonesia, Nigeria, Taiwan, USA) and three platforms (Bard, Bing, ChatGPT-3.5). Utilizing previously published cases, we asked identical questions to chatbots from each location within a 24-h window. Responses were evaluated in a double-blinded manner on relevance, clarity, depth, focus, and coherence by ten experts in endometrial cancer. Our analysis revealed significant variations across different countries/regions (p < 0.001). Interestingly, Bing's responses in Nigeria consistently outperformed others (p < 0.05), excelling in all evaluation criteria (p < 0.001). Bard also performed better in Nigeria compared to other regions (p < 0.05), consistently surpassing them across all categories (p < 0.001, with relevance reaching p < 0.01). Notably, Bard's overall scores were significantly higher than those of ChatGPT-3.5 and Bing in all locations (p < 0.001). These findings highlight disparities and opportunities in the quality of AI-powered healthcare information based on user location and platform. This emphasizes the necessity for more research and development to guarantee equal access to trustworthy medical information through AI technologies.
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Affiliation(s)
- Khanisyah E Gumilar
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia.
| | - Birama R Indraprasta
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Yu-Cheng Hsu
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Zih-Ying Yu
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC
| | - Hong Chen
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Budi Irawan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Zulkarnain Tambunan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Bagus M Wibowo
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Hari Nugroho
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Brahmana A Tjokroprawiro
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Erry G Dachlan
- Department of Obstetrics and Gynecology, Dr. Soetomo General Hospital-Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Pungky Mulawardhana
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia
| | - Eccita Rahestyningtyas
- Department of Obstetrics and Gynecology, Hospital of Universitas Airlangga-Faculty of Medicine, Universitas Airlangga, Jl. Dharmahusada Permai, Mulyorejo, Kec. Mulyorejo, Surabaya, Jawa Timur, 60115, Indonesia
| | - Herlangga Pramuditya
- Department of Obstetrics and Gynecology, Dr. Ramelan Naval Hospital, Surabaya, Indonesia
| | - Very Great E Putra
- Department of Obstetrics and Gynecology, Dr. Kariadi Central General Hospital, Semarang, Indonesia
| | - Setyo T Waluyo
- Department of Obstetrics and Gynecology, Ulin General Hospital, Banjarmasin, Indonesia
| | - Nathan R Tan
- Department of Modern and Classical Languages and Literature, University of South Alabama, Mobile, AL, USA
| | - Royhaan Folarin
- Department of Anatomy, Faculty of Basic Medical Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Ibrahim H Ibrahim
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Cheng-Han Lin
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Tai-Yu Hung
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan
| | - Ting-Fang Lu
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Yen-Fu Chen
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Shao-Jing Wang
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC
| | - Jingshan Huang
- School of Computing and College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Clayton C Yates
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology, Taichung Veteran General Hospital, 1650 Taiwan Boulevard Sector. 4, Taichung, 40705, Taiwan, ROC.
| | - Li-Na Liao
- Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC.
| | - Ming Tan
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
- Institute of Biochemistry and Molecular Biology, Graduate Institute of Biomedical Sciences, China Medical University (Taiwan), No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung, 406040, Taiwan, ROC.
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Song JS, Smith SP, Stucken CL. Implications of Malignancy, Radiation, and Timing of Major Nasal Reconstruction. Facial Plast Surg Clin North Am 2024; 32:189-198. [PMID: 38575277 DOI: 10.1016/j.fsc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Owing to the complex, multilayered anatomy of the nose in the central face, major nasal reconstruction can pose a significant challenge for reconstructive surgeons. It is the responsibility of reconstructive surgeons to have an understanding of the most common cutaneous malignancies and excisional techniques that may lead to complex nasal defects. The purpose of this article is to discuss these malignancies, excisional techniques, and impacts of radiation on tissue that has implications for reconstructive surgeons.
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Affiliation(s)
- Jin Soo Song
- Smith Facial Plastics, Columbus Ohio, 725 Buckles Court North #210, Gahanna, OH 43230, USA
| | - Stephen P Smith
- Smith Facial Plastics, Columbus Ohio, 725 Buckles Court North #210, Gahanna, OH 43230, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Marsidi N, Ottevanger R, Demir YE, van Beugen S, Goeman JJ, Genders RE. Patient-reported outcome measurements in facial skin surgery and a comparison between Mohs micrographic surgery and conventional excisions. J Eur Acad Dermatol Venereol 2024. [PMID: 38644735 DOI: 10.1111/jdv.20025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Knowledge of the psychosocial impact of facial skin surgery on patients can help improve counselling strategies. OBJECTIVES The objective was to measure the psychological impact of facial skin cancer surgery on patients over a 1-year period. Secondary objective was to measure the difference between Mohs micrographic surgery (MMS) and conventional excision (CE) on these parameters. METHODS This observational survey study was conducted between March 2019 and July 2020. Patients who had facial skin surgery using MMS or CE were selected. Five surveys were conducted on four timepoints (preoperative, 1 week, 3 months and 1 year post-operative) measuring the quality of life, perceived stigmatization, body image, satisfaction with facial appearance and psychosocial distress. RESULTS A total of 228 patients (MMS 154 patients, CE 74 patients) were included for the analysis. Scores for quality of life did not significantly change, in the year after surgery (PCS-12 mean 50.5, SD 9.3 and MCS-12 50.6, SD 9.4); however, stigmatization (F (3, 235,39) 7,26, p < 0.01, d = -0.07), body image concerns (F (3, 198,28) = 3.75, p < 0.01, d = -0.14), satisfaction with facial appearance (F (3, 205,18) = 10.74, p < 0.01, d = 0.43) and psychosocial distress (F (3, 208,69) = 9.26, p < 0.01, d = -0.15) did change over time. The use of MMS or CE did not significantly affect outcome scores after 1 year. CONCLUSION Patients receiving facial skin cancer surgery exhibited low scores for perceived stigmatization and body image concerns. Their quality of life was not statistically influenced by facial surgery, and their satisfaction with their facial appearance and psychosocial distress even improved after 1 year. The results suggest that the surgical treatment type (MMS or CE) does not influence the outcome. The overall results can help in counselling strategies to improve expectations for patients receiving facial surgery.
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Affiliation(s)
- N Marsidi
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Dermatology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - R Ottevanger
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y E Demir
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S van Beugen
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - J J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Dermatology, Roosevelt Kliniek, Leiden, The Netherlands
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Nierich J, Corten E, de Jong T, Mureau M. Long-Term Patient-Reported Outcomes following Oncological Facial Reconstructive Surgery using the FACE-Q Skin Cancer Module. JPRAS Open 2024; 39:262-270. [PMID: 38351901 PMCID: PMC10861937 DOI: 10.1016/j.jpra.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
Background Long-term patient-reported outcomes (PROs) of oncological facial reconstructive surgery are unknown. Objective The present study aimed to assess long-term PROs and to identify possible correlations between patient and treatment characteristics and long-term PROs. Methods & Materials Between 2006 and 2011, 202 patients underwent facial reconstruction after Mohs micrographic surgery for non-melanoma skin cancer at our institution. After 10 years of follow-up, 96 out of the remaining 122 patients completed the FACE-Q Skin Cancer Module. Results Patients who were surgically treated for squamous cell carcinoma reported poorer scores on the satisfaction with facial appearance (p=0.038), appraisal of scars (p=0.039) and appearance-related psychosocial distress scales (p=0.036) compared to patients with basal cell carcinoma and lentigo maligna. Finally, female patients reported significantly higher scores on the Cancer Worry Scale than male patients (p=0.047). Conclusion Long-term patient satisfaction with respect to their facial appearance and scars after reconstructive surgery for skin cancer was comparable to short-term patient satisfaction, whereas Cancer Worry Scale and psychosocial distress appeared to be slightly higher. Our results can be used to better inform patients on the long-term effects of facial reconstructive surgery on patient satisfaction and quality of life, which are important to improve patient counselling, patient expectation management and shared decision-making.
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Affiliation(s)
- J. Nierich
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E.M.L. Corten
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - T. de Jong
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M.A.M. Mureau
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Chen A, Ray P, Rogers H, Bialowas C, Butala P, Chen M, Daveluy SD, Davidson C, Faringer P, Guarda H, Kantor J, Kaweski S, Lawrence N, Lickstein D, Lomax J, Parra S, Retson N, Suryadevara A, Smith R, Tollefson TT, Wisco OJ. Evidence-Based Performance Measures for Reconstruction after Skin Cancer Resection: A Multidisciplinary Performance Measure Set. Plast Reconstr Surg 2024; 153:424e-441e. [PMID: 38266139 DOI: 10.1097/prs.0000000000010916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND The American Society of Plastic Surgeons commissioned the multidisciplinary Performance Measure Development Work Group on Reconstruction after Skin Cancer Resection to identify and draft quality measures for the care of patients undergoing skin cancer reconstruction. Included stakeholders were the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Dermatology, the American Society of Dermatologic Surgery, the American College of Mohs Surgery, the American Society for Mohs Surgery, and a patient representative. METHODS Two outcome measures and five process measures were identified. The outcome measures included the following: (1) patient satisfaction with information provided by their surgeon before their facial procedure, and (2) postprocedural urgent care or emergency room use. The process measures focus on antibiotic stewardship, anticoagulation continuation and/or coordination of care, opioid avoidance, and verification of clear margins. RESULTS All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the stakeholder societies. CONCLUSION The work group recommends the use of these measures for quality initiatives, Continuing Medical Education, Continuous Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.
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Affiliation(s)
| | - Peter Ray
- East Hills Professional Center and Marshall University Joan C. Edwards School of Medicine
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Kassotis AS, Grimes J, Samie FH, Lewin JM, Levenson JA, Glass LRD. Risk factors for developing depressive symptoms in the immediate postoperative period after Mohs micrographic surgery. Orbit 2024; 43:22-27. [PMID: 36847522 DOI: 10.1080/01676830.2023.2179639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Mohs micrographic surgery (MMS) is a highly efficacious, tissue sparing method of skin cancer removal. Nevertheless, in the months to years after MMS, psychosocial distress has been described. The present study addressed the immediate period after MMS and assessed the frequency and risk factors for development of depressive symptoms. METHODS Subjects undergoing MMS at two physician practices (JL, FS) were included in this prospective cohort study. Preoperatively, a standardized depression screening, the Patient Health Questionnaire-8 (PHQ-8), was administered. After MMS, the PHQ-8 was readministered at weeks 1, 2, 4, 6, and 12. Average PHQ-8 score by week and change from baseline PHQ-8 score were the primary outcomes. RESULTS Sixty-three subjects were included of which 49 (78%) had a facial site. Twenty-two subjects (35%) had some increase in score during the 12-week follow-up period, of which 18 had a facial site. The oldest subjects (83-99 years, n = 14) had significantly higher PHQ-8 scores at week 4 (p < 0.01) and week 6 (p = 0.02) than all other age groups. There were no differences in scores between location groups. CONCLUSIONS One-third of subjects had some increase in score during the follow-up period. Those in the oldest age cohort were at highest risk of increased score. In contrast to prior literature, those with facial sites were not at higher risk. This difference may be explained by increased masking during the ongoing COVID-19 pandemic. Ultimately, consideration of patients' psychologic status in the immediate postoperative period after MMS, particularly in the elderly population, may enhance perceived patient outcomes.
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Affiliation(s)
- Alexis S Kassotis
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Grimes
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesse M Lewin
- The Kimberly and Eric J. Waldman Department of Dermatology, Ichan School of Medicine at Mt. Sinai, New York, NY, USA
| | - Jon A Levenson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lora R Dagi Glass
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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Ou-Yang Y, Zheng Y, Mills KE. Photodynamic therapy for skin carcinomas: A systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1089361. [PMID: 36744141 PMCID: PMC9892842 DOI: 10.3389/fmed.2023.1089361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
Background Photodynamic therapy (PDT) is increasingly used for the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). However, it is unknown whether photodynamic therapy is more effective than other commonly used treatment modalities for these cancers. Purpose The aim of this study was to determine the relative efficacy and safety of PDT compared with placebo or other interventions for the treatment of skin carcinomas. Methods Searches were performed in PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials databases. We included randomized controlled trials comparing the PDT with other interventions in adults skin BCC or SCC that reported on lesion response, recurrence, cosmetic appearance, or safety outcomes. Results Seventeen unique randomized controlled trials, representing 22 study arms from 21 publications were included. The included trials included 2,166 participants, comparing methyl aminolevulinic (MAL) PDT (six studies) or aminolevulinic acid (ALA) PDT (two studies). Comparators included placebo, surgery, hexaminolevulinic (HAL) PDT, erbium: yttrium-aluminum-garnet ablative factional laser (YAG-AFL) PDT, fluorouracil, and imiquimod. There were few studies available for each comparison. Mantel-Haenszel fixed effects risk ratios were calculated for response, recurrence, cosmetic outcomes, and adverse events. MAL-PDT had similar response rates to surgery, ALA-PDT, fluorouracil and imiquimod at 3- and 12 months post-intervention. The rate of recurrence was similar, showing few differences at 12 months, but at later time points (24-60 months), fewer lesions recurred with surgery and imiquimod than with PDT. PDT also caused more adverse events and pain than other interventions. However, PDT treatment was more likely to receive a "good" or "excellent" rating for cosmetic appearance than surgery or cryotherapy. Conclusion This systematic review and meta-analysis demonstrates that the choice of treatment modality for BCC or SCC is best chosen in the context of the location and size of the lesion, the socioeconomic circumstances of the patient, as well as the patient's preferences. We call for more high quality studies to be done, in order to enable more reliable interpretations of the data. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=368626, identifier CRD42022368626.
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Affiliation(s)
- Yun Ou-Yang
- Department of Information, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China,Yun Ou-Yang,
| | - Yaowu Zheng
- Guangdong Nuohui Hospital Management LLC, Guangzhou, China
| | - Kerry E. Mills
- Department of Science and Technology, University of Canberra, Bruce, ACT, Australia,*Correspondence: Kerry E. Mills,
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Aleisa A, Veldhuizen I, Rossi AM, Nehal KS, Lee EH. Patient Education on Scarring Following Mohs Micrographic Surgery: Patient Preference for Information Delivery. Dermatol Surg 2022; 48:1155-1158. [PMID: 36342247 PMCID: PMC10231143 DOI: 10.1097/dss.0000000000003557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are multiple modalities for patient education ranging from written to audiovisual formats. However, little is known regarding which modality is optimal. OBJECTIVE To assess patient preference for educational materials about scar care following surgery for facial skin cancer using the FACE-Q Skin Cancer patient reported outcome measure. MATERIALS AND METHODS On the day of Mohs surgery, patients were given a written handout or viewed a 3-minute animation video regarding best practices in scar improvement. Afterward, patients received the FACE-Q Skin Cancer-Satisfaction with Information: Appearance scale. Three months later, patients were called and given the same scale and additional questions regarding scar care. RESULTS A total of 75 patients were enrolled. There was no difference between the 2 groups' preoperative information scores (p = .85) and the three-month postoperative scores (p = .37). The change in preoperative and postoperative score showed no significant difference between the 2 groups (p = .21); but there was a trend of higher satisfaction in the video group on the day of Mohs surgery. After the 3-month timepoint, there was a higher satisfaction trend observed with the written handout group. CONCLUSION Patient preferences in information delivery and accessibility will contribute to greater information retention and satisfaction.
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Affiliation(s)
- Abdullah Aleisa
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Inge Veldhuizen
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Plastic and Reconstructive Surgery, Nutrim, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anthony M. Rossi
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kishwer S. Nehal
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erica H. Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Gulati A, Grekin R, Neuhaus I, Saylor D, Yu S, Park A, Seth R, Knott PD. Long-Term Appearance-Related Outcomes of Facial Reconstruction After Skin Cancer Resection. Facial Plast Surg Aesthet Med 2022. [DOI: 10.1089/fpsam.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Roy Grekin
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Isaac Neuhaus
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Drew Saylor
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Siegrid Yu
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Andrea Park
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Rahul Seth
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - P. Daniel Knott
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
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11
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Veldhuizen IJ, Brouwer P, Aleisa A, Kurtansky NR, Dusza SW, Nehal KS, Hoogbergen MM, van der Hulst RR, Lee EH. Nasal skin reconstruction: Time to rethink the reconstructive ladder? J Plast Reconstr Aesthet Surg 2022; 75:1239-1245. [PMID: 34903490 PMCID: PMC8976754 DOI: 10.1016/j.bjps.2021.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/17/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nasal scarring can compromise aesthetics and function given its complex three-dimensional structure and central location. This study aimed to measure patients' satisfaction after reconstruction for nasal defects following Mohs micrographic surgery. METHODS Patients presenting with nasal nonmelanoma skin cancer at Memorial Sloan Kettering Cancer Center New York, USA and Catharina Hospital Eindhoven, Netherlands from April 2017 to November 2019 were asked to participate. Reconstruction type, complications, and patients satisfaction were assessed. Patients completed the FACE-Q Skin Cancer - Satisfaction with Facial Appearance scale (preoperative and 1-year postoperative) and the Appraisal of Scars scale (1-year postoperative). RESULTS A total of 128 patients completed the preand postoperative scales. There were 35 (27%) surgical defects repaired with primary closures, 71 (55.5%) with flaps, and 22 (17.2%) with full-thickness skin grafts (FTSG). Patients that underwent a flap or FTSG reconstruction had higher scar satisfaction scores than primary closures (p = 0.03). A trend was seen with patients following flap reconstructions scoring 7.8 points higher than primary closures and patients with upper nose defects scoring 6.4 points higher than lower nose defects. Males were significantly more satisfied than females. No significant difference was observed in the preoperative and postoperative facial appearance scores between the three groups (p = 0.39). CONCLUSION Patients are more satisfied in the long term with their scars after flap reconstructions compared to primary closures. Therefore, nasal skin reconstruction may not follow the traditional reconstructive ladder and more complex approaches may lead to higher long-term scar satisfaction.
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Affiliation(s)
- Inge J. Veldhuizen
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Plastic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Philip Brouwer
- Department of Plastic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Abdullah Aleisa
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Stephen W. Dusza
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kishwer S. Nehal
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - René R.W.J. van der Hulst
- Department of Plastic and Reconstructive Surgery, Nutrim, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erica H. Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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Facial Gender Surgery: Systematic Review and Evidence-Based Consensus Guidelines from the International Facial Gender Symposium. Plast Reconstr Surg 2022; 149:212-224. [PMID: 34936625 DOI: 10.1097/prs.0000000000008668] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing societal acceptance of transgender people has led to broader availability of gender surgery and rapid growth in transition-related operations. Facial gender surgery aims to modify patients' facial features to be more congruent with their physical expression of gender, reducing gender dysphoria and improving quality of life. Growth in research and technique evolution has not kept pace with growth in clinical volume. Therefore, the first International Facial Gender Symposium was held at Johns Hopkins University in 2019, convening surgeons who perform facial gender surgery to share ideas and assess the state of clinical evidence. METHODS To review the literature on facial gender surgery, the authors developed a search strategy for seven electronic databases (PubMed, PsycINFO, Embase, CINAHL, Web of Science, Cochrane, and Gender Studies) through May of 2019, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. RESULTS Based on the English language literature and clinical experience, the authors suggest guidelines for screening, management, and appropriate surgical technique for patients undergoing facial gender surgery. They highlight facial gender surgery as a medically necessary intervention and identify shortcomings in current guidelines. CONCLUSIONS Facial gender surgery represents a complex array of craniofacial and soft-tissue procedures that require application of advanced skills and decision-making. Facial gender operations are not cosmetic, are medically necessary, and require development of new CPT codes specific to facial gender surgery. It is imperative to create educational programs and methods to define sufficient training for facial gender surgery surgeons. Research priorities include better procedural outcomes data, more quality-of-life studies, and insight into variation in both patient and procedural subgroups.
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13
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Brambullo T, Azzena GP, Toninello P, Masciopinto G, De Lazzari A, Biffoli B, Vindigni V, Bassetto F. Current Surgical Therapy of Locally Advanced cSCC: From Patient Selection to Microsurgical Tissue Transplant. Review. Front Oncol 2021; 11:783257. [PMID: 34950589 PMCID: PMC8690035 DOI: 10.3389/fonc.2021.783257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Among the non-melanoma skin cancers (NMSC) the squamous cell carcinoma (SCC) is one of the most challenging for the surgeon. Local aggressiveness and a tendency to metastasize to regional lymph nodes characterize the biologic behavior. The variants locally advanced and metastatic require wide excision and node dissection. Such procedures can be extremely detrimental for patients. The limit of the surgery can be safely pushed forward with a multidisciplinary approach. The concept of skin oncoplastic surgery, the ablative procedures and the reconstructive options (skin graft, pedicled flap, microsurgical free flap) are discussed together with a literature review.
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Affiliation(s)
- Tito Brambullo
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Gian Paolo Azzena
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Paolo Toninello
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Giuseppe Masciopinto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Alberto De Lazzari
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Bernardo Biffoli
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Vincenzo Vindigni
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
| | - Franco Bassetto
- Clinic of Plastic Surgery, Department of Neurosciences, Padua University Hospital, Padua, Italy
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14
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Veldhuizen IJ, Budo J, Kallen EJJ, Sijben I, Hölscher MC, van der Hulst RRWJ, Hoogbergen MM, Ottenhof MJ, Lee EH. A Systematic Review and Overview of Flap Reconstructive Techniques for Nasal Skin Defects. Facial Plast Surg Aesthet Med 2021; 23:476-481. [PMID: 33650884 PMCID: PMC10027346 DOI: 10.1089/fpsam.2020.0533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Reconstruction of nasal skin defects can be challenging due to limited skin laxity and underlying cartilage and, therefore, often require a complex repair. The aim of this review is to systematically analyze the literature on nasal skin reconstructions with specific detail to flap reconstructions. Methods: A systematic literature review of nasal skin reconstruction was performed and focused on flap reconstructions. Flap reconstructions were stratified based on defect size, nasal subunit, and reconstruction type. Complication rates (CRs) and patient outcomes were also assessed. Results: A total of 176 articles (11,370 patients) met the inclusion criteria. Of these, 59 articles showed various flap techniques. For defects ≤1.5 cm, every subunit had four to six options except the alar rim, which showed one option. Rotation-advancement flaps were mostly used for the nasal tip and sidewall, whereas bilobed flaps were used more for the ala and dorsum. Defects >1.5 cm were most commonly reconstructed with the forehead flap. The mean CR of flap reconstructions was 13.8%. Only 8 of the 176 articles (4.5%) reported patient satisfaction using a standardized questionnaire. Conclusion: This review shows various flap reconstruction options with their corresponding CR that will help guide the surgeon in choosing reconstructive options for different nasal skin defects.
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Affiliation(s)
- Inge J Veldhuizen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jessie Budo
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Emily J J Kallen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Isha Sijben
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marleen C Hölscher
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - René R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Maarten J Ottenhof
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Erica H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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15
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Brewer JD. Commentary on Blood Perfusion of Random Skin Flaps in Humans-In Vivo Assessment By Laser Speckle Contrast Imaging. Dermatol Surg 2021; 47:1427. [PMID: 34366404 DOI: 10.1097/dss.0000000000003187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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16
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Ramírez-de Los Santos ML, López-Navarro A, Ramírez-de Los Santos S, Guzmán-Flores JM, Pereira-Suárez AL, López-Pulido EI. Relation between personality dimensions and symptomatology of depression in skin cancer patients. Biopsychosoc Med 2021; 15:18. [PMID: 34641938 PMCID: PMC8507346 DOI: 10.1186/s13030-021-00220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Environmental psychological factors such as mood states can modify and trigger an organic response; depressive disorder is considered a risk factor for oncological development, leading to alterations both in the genesis and in the progression of the disease. Some authors have identified that personality relates to mood since a high score in neuroticism is associated with intense and long-lasting emotions of stress and therefore with the development of depressive behaviors. The objective of this study was to analyze the relationship between personality and depression in skin cancer patients. METHODS A total of forty-seven clinically and histopathologically diagnosed patients were scheduled for an hour-long interview, during which they provided informed consent and sociodemographic information. The psychological questionnaires applied were the revised Eysenck Personality Questionnaire and the clinical questionnaire for the diagnosis of the depressive syndrome. RESULTS The patient's mean age was 66.5 years (SD ± 12.4) and the majority were diagnosed with basal cell carcinoma (70.2%). The frequency of anxious/depressive symptoms was 42.5%, with an increase in depression scores in the female gender (p < 0.001). Furthermore, a difference was found in the neuroticism dimension related to gender, with higher values in women (p = 0.002). Depressive symptomatologic portraits were correlated with the dimensions of neuroticism (p < 0.001, r = 0.705), psychoticism (p = 0.003, r = 0.422) and lying (p = 0.028, r = - 0.321). CONCLUSIONS Our results support the hypothesis that personality dimensions are related to the presence of anxiety/depressive symptomatology in patients with skin cancer, especially in the female gender. Highlighting the need for future research that delves into the implications at the psychological level, the quality of life, and the biological mechanisms that link personality and depressive symptoms in the development and evolution of skin cancer.
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Affiliation(s)
- M L Ramírez-de Los Santos
- Centro Universitario de los Altos, Universidad de Guadalajara, Road to Yahualica 7.5 Km, Jalisco, 47600, Tepatitlan de Morelos, Mexico
| | - A López-Navarro
- Centro Universitario de los Altos, Universidad de Guadalajara, Road to Yahualica 7.5 Km, Jalisco, 47600, Tepatitlan de Morelos, Mexico
| | - S Ramírez-de Los Santos
- Centro Universitario de los Altos, Universidad de Guadalajara, Road to Yahualica 7.5 Km, Jalisco, 47600, Tepatitlan de Morelos, Mexico
| | - J M Guzmán-Flores
- Centro Universitario de los Altos, Universidad de Guadalajara, Road to Yahualica 7.5 Km, Jalisco, 47600, Tepatitlan de Morelos, Mexico
| | - A L Pereira-Suárez
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - E I López-Pulido
- Centro Universitario de los Altos, Universidad de Guadalajara, Road to Yahualica 7.5 Km, Jalisco, 47600, Tepatitlan de Morelos, Mexico.
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17
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Kinde B, Idowu OO, Ashraf DC, Chen RM, Hirabayashi KE, Grob SR, Winn BJ, Kersten RC, Vagefi MR. Quality-of-Life Outcomes for Excision and Reconstruction of Periocular Nonmelanoma Skin Cancer. Facial Plast Surg Aesthet Med 2021. [PMID: 34227877 DOI: 10.1089/fpsam.2020.0647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding how periocular nonmelanoma skin cancer (NMSC) impacts quality of life (QoL) provides insight into the patient experience. Objective: To prospectively measure QoL of individuals with surgically treated periocular NMSC. Methods: Responses to the skin cancer index (SCI) and FACE-Q questionnaires were obtained at preoperative (PRE), postoperative week 1 (POW1), and postoperative month 3 (POM3) visits. Statistical analysis was performed using paired t-test and stepwise linear regression. Results: Forty-five patients participated in the study. Improved QoL as reflected in an increased mean difference of the total SCI score at PRE and POM3 visits (25.8, 95% confidence interval [CI 20.0 to 31.6]) and FACE-Q early life impact of treatment score at POW1 and POM3 visits (19.0, 95% CI [14.9 to 23.0), and a decreased mean difference of the FACE-Q adverse effects score at POW1 and POM3 visits (-1.3, 95% CI [-2.4 to -0.1]) was observed. Linear regression of the SCI and FACE-Q scores using demographic and clinical attributes revealed several predictors of postoperative QoL. Conclusions: Surgical management of periocular NMSC results in improved QoL, demonstrated at the final postoperative visit.
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Affiliation(s)
- Benyam Kinde
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Davin C Ashraf
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Kristin E Hirabayashi
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Seanna R Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
- Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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18
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Zebolsky AL, Ochoa E, Badran KW, Heaton C, Park A, Seth R, Knott PD. Appearance-Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction. Laryngoscope 2021; 131:E2204-E2211. [PMID: 33797087 DOI: 10.1002/lary.29548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS To better understand aesthetic patient-reported outcomes and psychosocial quality of life (QOL) after head and neck microvascular reconstruction for benign or malignant tumors. STUDY DESIGN Single-center prospectively obtained in-office validated questionnaire-based study. METHODS Analysis of prospectively collected surveys at a tertiary care academic center from June 2018 to February 2021. Patients completed two FACE-Q scales: Appearance-Related Psychosocial Distress (ARPD) and Social Function (SF). Survey scores, demographics, operative course, and adjuvant therapy data underwent univariate and multivariable analyses. RESULTS One hundred and three patients completed surveys at a median of 13.5 months postoperatively (interquartile range: 5.2-30.8). Mean ARPD from 0 (no distress) to 100 (maximum distress) was 32.4 (standard error of the mean [SEM]: 2.7). Mean SF from 0 (worst functioning) to 100 (best functioning) was 55.5 (SEM: 2.7). Postoperative adjuvant radiation was associated with 13.9% higher ARPD (95% CI: 3.4-24.4, P = .019) and 10.4% lower SF (95% CI: -20.7 to -0.1, P = .047). Each appearance-related question on the ARPD scale independently predicted impaired SF (P < .001 for all questions). Upon multivariable logistic regression, osteocutaneous reconstruction, compared to soft tissue alone (P = .043), and postoperative adjuvant radiation (P = .014) were associated with higher levels of ARPD. Age, sex, relationship status, anxiety or depression history, defect location, and hospital stay were not significantly associated with ARPD or SF scores. CONCLUSIONS Aesthetic outcomes are important determinants of psychosocial QOL following head and neck microvascular reconstruction: an effect that is worsened by adjuvant radiation. Reconstructive surgeons should prioritize aesthetic outcomes, in addition to functional restoration, to optimize social functioning in patients with head and neck tumors. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2204-E2211, 2021.
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Affiliation(s)
- Aaron L Zebolsky
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Edgar Ochoa
- School of Medicine, University of California - San Francisco, San Francisco, California, U.S.A
| | - Karam W Badran
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Chase Heaton
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Andrea Park
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - P Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
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19
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Pagotto VPF, Tutihashi RMC, Ribeiro RDA, Takahashi GG, Camargo CP, Busnardo FDF, Gemperli R. Application of FACE-Q and NOSE in Nasal Reconstruction with Paramedian Frontal Flap after Skin Cancer Resection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3533. [PMID: 33854868 PMCID: PMC8032362 DOI: 10.1097/gox.0000000000003533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/17/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Nonmelanoma skin cancer (NMSC) is responsible for high morbidity and mortality, resulting in a high cost to the health system. The nose is the leading region affected by this type of tumor and may need reconstruction by tissue transfer. The paramedian forehead flap (PFF) is one of the main options used, and the factors that influence the result should be studied. The FACE-Q questionnaire allows the assessment of appearance, quality of life, and side effects related to the procedure, whereas the Nasal Obstruction Symptom Evaluation questionnaire enables the nose function evaluation. METHODS This study evaluates nasal reconstruction with a PFF after resection of NMSC with the FACE-Q questionnaire and Nasal Obstruction Symptom Evaluation. Spearman Rank correlation coefficient tests between the questionnaire results and patients' characteristics were performed. RESULTS The questionnaires were completely answered by 49 patients who underwent this reconstruction between 2011 and 2019 in a cancer center. The patients' evaluations demonstrate high satisfaction with appearance, quality of life, side effects, and function. Completing reconstruction under 6 months was associated with a higher quality of life among patients (P = 0.002). Reconstruction of lining or scaffold, moment of flap division, complications, and number of operations did not show an association. CONCLUSION This study suggests that the PFF is a reliable option for nasal reconstruction. Identifying the total reconstruction time as an impact factor on patients' quality of life should be considered when planning treatment.
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Affiliation(s)
| | | | - Renan Diego Americo Ribeiro
- From the Division of Plastic Surgery, Medical School, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Giulia Godoy Takahashi
- From the Division of Plastic Surgery, Medical School, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Cristina Pires Camargo
- Plastic Surgery Laboratory (LIM04), Medical School, Universidade de São Paulo, São Paulo, Brazil
| | - Fábio de Freitas Busnardo
- From the Division of Plastic Surgery, Medical School, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Rolf Gemperli
- From the Division of Plastic Surgery, Medical School, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
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20
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Veldhuizen IJ, Lee EH, Kurtansky NR, van Hensbergen LJ, Dusza SW, Hölscher MC, van der Hulst RRWJ, Ottenhof MJ, Pusic AL, Hoogbergen MM. To see or not to see: Impact of viewing facial skin cancer defects prior to reconstruction. Arch Dermatol Res 2021; 313:847-853. [PMID: 33515277 DOI: 10.1007/s00403-021-02187-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 01/28/2023]
Abstract
Patient expectations of the scar after Mohs micrographic surgery (MMS) are often not realistic, leading to subsequent psychosocial sequelae such as anxiety, depression, and avoidance of social situations. When patient expectations are not met, this may also contribute to a decrease in patient satisfaction after surgery. Therefore, altering expectation levels may change patient satisfaction and psychosocial distress levels after surgery. To assess whether patient satisfaction improves in patients after MMS when patients view the surgical defect prior to reconstruction. Patients undergoing facial MMS between December 2017 and September 2019 were included. Patients received or did not receive a mirror after MMS to view the surgical defect before closing the defect. Patients were asked to complete the Dutch FACE-Q Skin Cancer before, one-week, three-months, and one-year after MMS. A total of 113 patients where included. One-hundred-eight (95.6%), 113 (100%), and 93 (82.3%) questionnaires were completed, one-week, three-months, and one-year follow-up, respectively. Satisfaction with facial appearance and appraisal of scars significantly improved over time for all patients, no such improvement was seen for appearance-related distress. Female patients who looked in the mirror had higher satisfaction with facial appearance than female patients who did not look in the mirror. Also, lower appearance-related distress scores were seen in patients who looked in the mirror prior to a flap reconstruction. Showing the defect in the mirror prior to the reconstruction may result in higher patient satisfaction in female patients and patients before undergoing a flap reconstruction.
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Affiliation(s)
- Inge J Veldhuizen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.,Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Plastic and Reconstructive Surgery, Nutrim, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erica H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Lucy J van Hensbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Stephen W Dusza
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Marleen C Hölscher
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - René R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Nutrim, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maarten J Ottenhof
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Andrea L Pusic
- Plastic and Reconstructive Surgery Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
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21
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Johnson TM, Smith NR. Mohs Surgery versus Standard Local Excision for Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma Skin Cancer. Facial Plast Surg 2020; 36:133-140. [PMID: 32413920 DOI: 10.1055/s-0040-1709142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Basal cell carcinoma, squamous cell carcinoma, and melanoma represent the three most common skin cancers that occur on the face. The most common surgical treatments for facial skin cancers are Mohs' surgery and standard local excision. The effective utilization of either of these techniques is based on tumor and patient risk stratification incorporating known risk factors for occult invasion and local recurrence, combined with patient comorbidities, expectations, and desires. Best available evidence highlights multiple and consistent risk factors for each specific skin cancer type, and dictate local control rates reported in the literature. Recognizing gaps in the literature, we compare and review surgical treatment guidelines and data for standard local excision versus Mohs' surgery for cutaneous nonmelanoma and melanoma skin cancer. This article serves as a resource for optimal therapeutic decision making for surgical management of skin cancer on the face.
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Affiliation(s)
- Timothy M Johnson
- Department of Dermatology, Otolaryngology, and Surgery, University of Michigan, Ann Arbor, Michigan
| | - Noah R Smith
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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