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Rosenthal BE, Schaubel DE, Lewis JD, Margolis DJ, Goldberg DS, Bittermann T. Immunosuppression regimen and latitude impact keratinocyte carcinoma risk in U.S. liver transplant recipients. Arch Dermatol Res 2024; 316:641. [PMID: 39325226 PMCID: PMC11427564 DOI: 10.1007/s00403-024-03404-3] [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: 07/16/2024] [Revised: 09/05/2024] [Accepted: 09/14/2024] [Indexed: 09/27/2024]
Abstract
Immunosuppression after solid organ transplantation is associated with an increased risk of keratinocyte carcinoma (KC). Despite its established morbidity, KC risk in liver transplant (LT) recipients is understudied, including the contribution of immunosuppression regimen and latitude. A retrospective cohort of 9,966 adult first LT alone recipients alive with their native allograft at 1-year post-LT without prior KC between 2007 and 2016 were identified using linked data from the Organ Procurement and Transplantation Network and Medicare administrative claims. The primary exposures were immunosuppression regimen and latitude of residence. The primary outcome was incident, de novo KC occurring at least 1-year after LT. Adjusted Cox regression analysis stratified by transplant center was used in all analyses. The cohort was 63.4% male, 70.2% White and with median age 61 years (interquartile range, IQR, 54-66) at transplant. Calcineurin inhibitor (CNI) with anti-metabolite combination was independently associated with incident KC when measured as intention-to-treat (adjusted hazard ratio (aHR) 1.21 vs. CNI monotherapy, 95% CI 1.02-1.43, p = 0.026), in a time-updating as-treated analysis (aHR 1.61, 95% CI 1.34-1.93; p < 0.001) and when measured as cumulative exposure (aHR 1.13 per 6-month increase, 95% CI: 1.02-1.33; p = 0.027). More southern latitude of residence was also independently associated with incident KC with an aHR of 1.26 per 5°N decrease towards the Equator (95% CI: 1.08-1.47, p = 0.003). We demonstrate independent effects of CNI with antiM immunosuppression regimen and latitude of residence on the risk of post-LT KC, which will better inform screening practices and immunosuppression management.
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Affiliation(s)
| | - Douglas E Schaubel
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - James D Lewis
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David J Margolis
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - David S Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Therese Bittermann
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Hospital of the University of Pennsylvania, 2 Dulles - Penn Transplant Institute, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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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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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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Qin N, Ma J, Lee EH, Barker CA. Quality of Life Before and After Radiation Therapy for Early-Stage Keratinocyte Carcinoma: A Longitudinal Analysis. Int J Radiat Oncol Biol Phys 2023; 117:1090-1095. [PMID: 37791935 PMCID: PMC11290081 DOI: 10.1016/j.ijrobp.2023.05.044] [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] [Received: 03/17/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Little is known about patient-reported quality of life (QOL) before and after radiotherapy (RT) for early keratinocyte carcinoma (KC). The present study tested the hypothesis that QOL is hypothesized to deteriorate soon after RT, with subsequent improvement of a magnitude similar to other KC treatments. METHODS AND MATERIALS This observational study assessed prospectively collected longitudinal patient-reported QOL data at a single center. Patients undergoing external beam RT for early-stage (T0-2, <4 cm) KC that completed the Skindex-16 (S16) or Skin Cancer Index (SCI) before and at least once after RT were included. These indices include subscales of symptoms, emotions, and functioning for S16 and emotional, social, and appearance for SCI. RESULTS 81 patients (median age 79 years) were treated for early KC, most being basal cell carcinomas (87%) on the face (80%) an average of 1.3 cm in diameter. Composite S16 scores and total SCI scores showed significant, clinically meaningful improvements at 3 months and 6 weeks after RT, respectively. QOL declined at 6 weeks after treatment on the S16 symptoms subscale. Concurrently, S16 and SCI emotional subscales significantly improved, and this trend persisted for 2+ years. Improvements in S16 functioning and SCI social and appearance QOL occurred after RT. The magnitude of improvement in QOL 3-12 months after RT was comparable to what has been previously reported after other types of KC treatments, like surgery. CONCLUSIONS QOL related to symptoms deteriorates during the first 6 weeks after RT for early KC, but it improves by 3 months. QOL related to emotions, functioning, social, and appearance all improve after RT. These changes in QOL are similar to those observed after other treatments of early KC.
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Affiliation(s)
- Nancy Qin
- Departments of Radiation Oncology and
| | | | - Erica H Lee
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Cao C, Wang N, Liu R, Patel AV, Friedenreich CM, Yang L. Leisure-time physical activity, daily sitting time, and mortality among US skin cancer survivors. Support Care Cancer 2023; 31:718. [PMID: 37999788 PMCID: PMC11121757 DOI: 10.1007/s00520-023-08192-6] [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: 08/18/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To investigate the long-term effect of sitting time and physical activity after a skin cancer diagnosis. METHODS A cohort of a nationally representative sample of skin cancer survivors (n=862) and non-cancer adults (n=13691) ≥50 years from the US National Health and Nutrition Examination Survey. Mortality data were linked through December 31, 2019. RESULTS During up to 13.2 years of follow-up (median, 6.3 years; 94,093 person-years), 207 deaths (cancer: 53) occurred in skin cancer survivors and 1970 (cancer: 414) in non-cancer adults. After adjusting for covariates and skin cancer type, being active was associated with lower risks of all-cause (HR=0.69; 95% CI: 0.47 to 1.00) and non-cancer (HR=0.59; 95% CI: 0.36 to 0.97) mortality compared to being inactive among skin cancer survivors. Meanwhile, sitting 8 h/d was associated with higher risks of all-cause (HR=1.72; 95% CI: 1.11 to 2.67) and non-cancer (HR=1.76; 95% CI: 1.07 to 2.92) mortality compared to sitting <6 h/d. In the joint analysis, inactive skin cancer survivors sitting >8 h/d had the highest mortality risks from all-cause (HR=2.26; 95% CI: 1.28 to 4.00) and non-cancer (HR=2.11; 95% CI,1.10 to 4.17). Additionally, the associations of LTPA and sitting time with all-cause and cause-specific mortality did not differ between skin cancer survivors and non-cancer adults (all P for interaction>0.05) CONCLUSION: The combination of prolonged sitting and lack of physical activity was associated with elevated risks of all-cause and non-cancer deaths among US skin cancer survivors. Skin cancer survivors could benefit from maintaining a physically active lifestyle.
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Affiliation(s)
- Chao Cao
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Nan Wang
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Raymond Liu
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Hora EC, Lima MS, Siqueira HFF, Marques AD, de Abreu Costa Brito É, Lessa AL, Lima CA. Cross-cultural adaptation of the Skin Cancer Index into Brazilian Portuguese for patients with cervicofacial nonmelanoma skin cancer. Support Care Cancer 2023; 31:590. [PMID: 37740741 PMCID: PMC10517893 DOI: 10.1007/s00520-023-08051-4] [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: 05/26/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE This study aimed to translate the Skin Cancer Index (SCI) into Portuguese, adapt it for Brazilian culture, and clinically validate it. METHODS A five-stage cross-cultural adaptation model was followed, with subsequent clinical validation. Inter-rater agreement was assessed using the content validity index (CVI). The hypothesis of the non-inferiority of the CVI at 80% probability level was evaluated using an exact binomial test. We used Spearman's rank-order and Pearson's product-moment correlation analysis, internal consistency using McDonald's ω and Cronbach's α metric, and construct validity using confirmatory factor analysis. The factorial model was validated using the chi-squared test, root mean square error of approximation (RMSEA), comparative fit index (CFI), and standardized root mean square residual (SRMR). RESULTS The first stage yielded two independent translations. After synthesis, back-translation, and review, the prefinal version was tested on 40 patients. Inter-rater agreement indices on content validity were significantly higher than 80% (p < 0.05). The SCI remained stable, and the Spearman's rank-order (rs), Pearson product-moment (r), and intraclass correlation coefficients were > 0.9, indicating excellent reliability. The reliability of McDonald's ω was considered ideal (> 0.8) in all subdimensions and scale. Cronbach's α was considered ideal in the "Emotional" and "Social" subdimensions and scale. Construct validity was observed in all subdimensions and scale through the criteria (χ2) p value > 0.05, RMSEA < 0.08, CFI ≥ 0.9, and SRMR ≤ 0.08. CONCLUSION The cross-cultural adaptation of the SCI to Portuguese for Brazilian culture showed content validity and reliability, contributing to quality of life assessment in patients with NMSC.
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Affiliation(s)
- Evânia Curvelo Hora
- Emergency Hospital of Sergipe (Hospital de Urgências de Sergipe), Aracaju, Sergipe, Brazil.
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil.
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil.
| | - Marcela Sampaio Lima
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Hianga Fayssa Fernandes Siqueira
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe (Lagarto Campus), Lagarto, Sergipe, Brazil
| | - Adriane Dórea Marques
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- Ministry of Health (Ministério da Saúde-MS), Aracaju, Sergipe, Brazil
| | - Érika de Abreu Costa Brito
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Arthur Leite Lessa
- School of Medicine, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Carlos Anselmo Lima
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
- State Department of Health (Secretaria de Estado da Saúde), Aracaju, Sergipe, Brazil
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Kuo AM, Lee EH, Rossi AM, Nehal KS, Cordova MA, Steckler AM, Lian M, Cohen G, Zhang Z, Zelefsky MJ, Kasper ME, Barker CA. A Multicenter Prospective Trial of Electronic Skin Surface Brachytherapy for Keratinocyte Carcinoma: Early Cosmesis, Quality of Life, and Adverse Events. Int J Radiat Oncol Biol Phys 2023; 116:544-550. [PMID: 36586493 PMCID: PMC10686635 DOI: 10.1016/j.ijrobp.2022.12.032] [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] [Received: 06/16/2022] [Revised: 11/29/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Keratinocyte carcinomas are amenable to many treatments, including radiation therapy (RT). Electronic skin surface brachytherapy (ESSB) enables the precise delivery of radiation without radioisotopes. In this prospective multicenter clinical trial, we characterized early outcomes of ESSB prospectively through both patient- and clinician-reported measures. To corroborate the cosmesis observations, we also assessed patient-reported quality of life (QoL) and adverse events. METHODS AND MATERIALS Patients ≥60 years old with stage T1N0M0 keratinocyte carcinoma were treated with ESSB. At 2-, 6-, and 12-weeks post-treatment, cosmesis from ESSB was assessed by both the patient and a clinician study investigator as either "good," "fair," or "bad." The Skindex-16 and the Skin Cancer Index (SCI) were used to assess patient QoL before and after treatment. Adverse events were assessed using the Common Toxicity Criteria for Adverse Events, version 4.0. RESULTS Cosmesis and QoL were collected at 97% (99/102) of possible patient follow-up times. By 12 weeks post-treatment, 93.9% (31/33) of patient-reported and 96.9% (31/32) of clinician-reported cosmesis outcomes were "good." Compared with baseline, total Skindex-16 score significantly deteriorated at 2 weeks post-treatment (10.5 vs 24.5, P <.001), but significantly improved at 6 weeks (10.5 vs 4.7, P = .014) and 12 weeks (10.5 vs 2.1, P = .001) post-treatment. The total SCI score significantly improved from baseline to 6 weeks (78.4 vs 89.0, P = .001) post-treatment. The most frequent adverse events were radiation dermatitis, skin pain, and pruritus. All adverse events resolved to Grade ≤1 by 12 weeks post-treatment. CONCLUSIONS This prospective, multicenter study demonstrated that ESSB is associated with a high rate of "good" early patient-reported cosmesis and increasing QoL and satisfaction with time. Validated assessments demonstrated a significant improvement in quality of life and resolution of moderate early adverse events by 6 to 12 weeks after treatment and corroborate the observation of favorable cosmesis.
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Affiliation(s)
- Alyce M. Kuo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erica H. Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Ming Lian
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gil’ad Cohen
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zhigang Zhang
- Memorial Sloan Kettering Cancer Center, New York, NY
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Quantification of Erythema Associated With Varying Suture Materials in Facial Surgery Repair: A Randomized Prospective Study. Dermatol Surg 2022; 48:1289-1293. [DOI: 10.1097/dss.0000000000003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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10
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Shao K, Zullo SW, Fix W, Taylor L, Zhang J, Miller CJ, Etzkorn JR, Shin TM, Giordano CN, Higgins WH, Sobanko JF. Measuring Stakeholder Assessments of Postsurgical Facial Scars: A Retrospective Cohort Inter-rater Analysis of Patients, Physicians, and Medical Student Observers. Dermatol Surg 2022; 48:418-422. [PMID: 35165219 DOI: 10.1097/dss.0000000000003405] [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: 11/26/2022]
Abstract
BACKGROUND The relationship of postoperative facial scar assessments among patients, physicians, and societal onlookers is not clearly defined. OBJECTIVE To identify differences in perceived scar outcomes by different stakeholders. METHODS AND MATERIALS Retrospective cohort study at a single Mohs micrographic surgery (MMS) center during which scars were assessed by: patients, physicians, and medical student observers not involved in patients' care using the Patient and Observer Scar Assessment Scale (v.2). Eighty-one patients graded their scars at 2 visits: 1 to 2 weeks post-MMS and 3 months post-MMS. Deidentified patient photographs were taken at each visit and graded by 4 physicians and 12 observers. RESULTS At week 1, there was a significant difference in overall opinion of scar appearance between patient and physicians (p = .001) and medical student observers and physicians (p < .001). Physicians graded scars more favorably. At 3 months, there remained a difference in scar evaluations between patient and physicians (p = .005), whereas medical student observers rated scars more similarly to physicians (p = .404). CONCLUSION Postoperative scar perceptions differ among stakeholders. Physicians must be mindful of this disparity when counseling patients in the perioperative setting to align patient expectations with realistic scar outcomes.
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Affiliation(s)
- Kimberly Shao
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Shannon W Zullo
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - William Fix
- Division of Dermatology, Albert Einstein College of Medicine, New York, New York
| | - Lynne Taylor
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junqian Zhang
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William H Higgins
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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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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Lukowiak TM, Perz AM, Veerabagu SA, Lee MP, Neal D, Aizman L, Miller CJ, Golda N, Albertini JG, Holmes T, Bar A, Leitenberger J, Maher IA, Sobanko JF, Chen D, Aasi S, Sutton A, Higgins HW, Shin TM, Weinberger C, Mattox A, Wysong A, Etzkorn JR. Patient Quality of Life After Interpolated Flap Repair of Nasal Mohs Surgery Defects: A Multicenter Prospective Cohort Study. JAMA Dermatol 2021; 157:1213-1216. [PMID: 34431977 DOI: 10.1001/jamadermatol.2021.3161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Single-center studies have shown that patients report better skin cancer-specific quality of life (QOL) after Mohs micrographic surgery (MMS), but it is unclear whether this improved QOL applies to patients after MMS and complex reconstruction in cosmetically sensitive areas. Objective To evaluate patient QOL after MMS and interpolation flap reconstruction for patients with nasal skin cancers. Design, Setting and Participants This multicenter prospective survey study used the Skin Cancer Index (SCI), a validated, 15-question QOL questionnaire administered at 4 time points: before MMS, 1 week after flap placement, 4 weeks after flap takedown, and 16 weeks after flap takedown. Patients age 18 years or older with a nasal skin cancer who presented for MMS and were anticipated to undergo 2-stage interpolated flap repair by a Mohs surgeon were recruited from August 9, 2018, to February 2, 2020, at 8 outpatient MMS locations across the United States, including both academic centers and private practices. Main Outcomes and Measures Mean difference in overall SCI score before MMS vs 16 weeks after flap takedown. Results A total of 169 patients (92 men [54.4%]; mean [SD] age, 67.7 [11.4] years) were enrolled, with 147 patients (75 men [51.0%]; mean [SD] age, 67.8 [11.7] years) completing SCI surveys both before MMS and 16 weeks after flap takedown. Total SCI scores improved significantly 16 weeks after flap takedown compared with pre-MMS scores, increasing by a mean of 13% (increase of 7.11 points; 95% CI, 5.48-8.76; P < .001). All 3 SCI subscale scores (emotion, appearance, and social) improved significantly (emotion subscale, increase of 3.27 points; 95% CI, 2.35-4.18; P < .001; appearance subscale, increase of 1.65 points; 95% CI, 1.12-2.18; P < .001; and social subscale, increase of 2.10 points; 95% CI, 1.55-2.84; P < .001) 16 weeks after flap takedown compared with pre-MMS. Conclusions and Relevance Removal of a nasal skin cancer and repair of the resulting defect can be distressing for patients. However, this cohort study suggests that physicians referring patients for MMS can be reassured that their patient's QOL will improve on average after surgery, even when a complex reconstruction is required.
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Affiliation(s)
- Tess M Lukowiak
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Allison M Perz
- Cooper Medical School of Rowan University, Camden, New Jersey
| | | | | | - Donald Neal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Leora Aizman
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Nicholas Golda
- Department of Dermatology, University of Missouri, Columbia
| | | | - Todd Holmes
- Division of Dermatology, University of Vermont Medical Center, Burlington
| | - Anna Bar
- Department of Dermatology, Oregon Health & Science University, Portland
| | | | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - David Chen
- Division of Dermatology, University of Vermont Medical Center, Burlington
| | - Sumaira Aasi
- Department of Dermatology, Stanford University, Stanford, California
| | - Adam Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | | | - Adam Mattox
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia.,Associate Editor, JAMA Dermatology
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13
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van Hensbergen LJ, Veldhuizen IJ, Lee EH, Houterman S, Brinkhuizen T, van der Hulst RRWJ, Hoogbergen MM. Cancer worry after facial nonmelanoma skin cancer resection and reconstruction: A 1-year prospective study. Psychooncology 2021; 31:238-244. [PMID: 34519388 DOI: 10.1002/pon.5810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/24/2021] [Accepted: 08/11/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Nonmelanoma skin cancer (NMSC) is one of the most diagnosed cancers in the world, with the number of new occurrences rising every year. Most patients with facial skin cancer experience cancer-related worry. Yet, little is known about their worry during the period after cancer treatment. This study aimed to assess the long-term change of cancer worry after surgical treatment in patients with NMSC. METHODS Patients undergoing surgery for facial NMSC between December 2017 and March 2020 were asked to complete the FACE-Q Skin Cancer-Cancer Worry scale before (baseline), 3-month, and 1-year post-surgery. RESULTS A total of 151 patients completed the baseline and 3-month, and 99 (65.6%) the 1-year post-operative survey. A significant decrease in cancer worry score was seen between baseline and 3-month post-surgery (p < 0.001). No difference was found between the 3-month and 1-year post-surgery scores (p = 0.78). Less improvement in cancer worry was seen for patients who had one facial skin cancer in their medical history (p = 0.001) and patients who had a history of facial surgery (p < 0.001). CONCLUSION Post-surgery patients still experience cancer worry. Therefore, targeted counseling might be of value when coping with cancer-related concerns. Patients with a history of facial NMSC and patients with a history of facial surgery might benefit from additional counseling.
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Affiliation(s)
- Lucy J van Hensbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Inge J Veldhuizen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands.,Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erica H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Tjinta Brinkhuizen
- Department of Dermatology, Catharina Hospital, 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 M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, The Netherlands
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14
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Kim J, Jo MW, Lee HJ, Ahn SH, Son BH, Lee JW, Lee SB. Validity and reliability of the Health-Related Quality of Life Instrument with 8 Items (HINT-8) in Korean breast cancer patients. Osong Public Health Res Perspect 2021; 12:254-263. [PMID: 34465074 PMCID: PMC8408420 DOI: 10.24171/j.phrp.2021.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/11/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study evaluated the validity and reliability of the Health-Related Quality of Life Instrument with 8 Items (HINT-8) in postoperative breast cancer patients in South Korea. METHODS The study included 300 breast cancer patients visiting a tertiary hospital. We measured health-related quality of life (HRQoL) using the HINT-8, the 5-level EQ-5D version (EQ-5D-5L), and the Functional Assessment of Cancer Therapy-Breast (FACT-B). Discriminatory ability, known-group validity, and convergent validity were assessed. Reliability was evaluated with the Cohen kappa, weighted kappa, and intraclass correlation coefficient (ICC). RESULTS The EQ-5D-5L indexes (p<0.001) and EQ visual analogue scale (VAS) scores (p<0.001) were significantly higher in subjects with no problems in each item of the HINT-8 than in those with problems. The FACT-B total scores were also higher in subjects without problems on the HINT-8. Older age, lower education level, and comorbidities were associated with a lower HINT-8 index. The HINT-8 index was correlated with the EQ-5D-5L index and the EQ VAS, with correlation coefficients of 0.671 (p<0.001) and 0.577 (p<0.001), respectively. The correlation coefficients between the HINT-8 and the FACT-B ranged from 0.390 to 0.714. The ICC was 0.690 (95% confidence interval, 0.580-0.780). CONCLUSION The HINT-8 showed appropriate validity for capturing HRQoL in postoperative breast cancer patients.
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Affiliation(s)
- Juyoung Kim
- Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Woo Jo
- Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeon-Jeong Lee
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sei-Hyun Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Lake E. JAAD Game Changers∗: Patient quality of life fluctuates before and after Mohs micrographic surgery: A longitudinal assessment of the patient experience. J Am Acad Dermatol 2021; 85:1071. [PMID: 33848601 DOI: 10.1016/j.jaad.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
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16
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El Abbadi S, Susok L, Stockfleth E, Bechara FG, Gambichler T, Herbrandt S, Goldschmidtböing L, Sand M. Comparison of the Skin Cancer Quality of Life Impact Tool and the Skin Cancer Index Questionnaire in Measurement of Health-Related Quality of Life and the Effect of Patient Education Brochures in Patients with Actinic Keratosis, Non-melanoma Skin Cancer, and Cutaneous Melanoma. Dermatol Ther (Heidelb) 2021; 11:929-940. [PMID: 33847880 PMCID: PMC8163937 DOI: 10.1007/s13555-021-00522-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/26/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Few studies have evaluated patient-reported outcome measures and the effect of patient educational materials in German patients with skin cancer. We conducted a prospective study to measure the impact of treatment on health-related quality of life in German patients with skin cancer, identify variables that may contribute to changes in health-related quality of life, and evaluate the effect of providing additional information through a patient education brochure. Methods A total of 461 patients diagnosed with actinic keratosis, nonmetastatic nonmelanoma skin cancer, melanoma in situ, or nonmetastatic cutaneous melanoma treated between August 2018 and July 2020 were included. Ninety-seven patients were randomly selected to receive an additional patient education brochure (“Hautkrebs”). The patients completed a Skin Cancer Quality of Life Index Tool (n = 324) or a Skin Cancer Index Questionnaire (n = 137) 1 week after surgical treatment. Results Ninety-seven patients were provided an additional patient education brochure. We found statistical correlation between sociodemographic factors (young age and female gender) and the location of the skin cancer (head and face) and impairment of health-related quality of life in patients with skin cancer (p < 0.05). Moreover, we found that patients who were presented a brochure showed significantly higher awareness concerning direct sun exposure (p < 0.05). Conclusion Impaired health-related quality of life is correlated with a patient with skin cancer’s age, gender, and the location of the lesion. Physicians should consider these factors in clinical practice and advocate the use of patient education brochures as effective assets in preventing the reoccurrence of skin cancer.
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Affiliation(s)
- Sam El Abbadi
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital OWL, Campus Klinikum Bielefeld Center, Bielefeld, Germany
| | - Laura Susok
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Egger Stockfleth
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Falk Georges Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Swetlana Herbrandt
- Department for Statistical Consulting and Analysis, Center for Higher Education, Technical University of Dortmund, Dortmund, Germany
| | - Lisa Goldschmidtböing
- Department for Statistical Consulting and Analysis, Center for Higher Education, Technical University of Dortmund, Dortmund, Germany
| | - Michael Sand
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany. .,Department of Plastic, Reconstructive and Aesthetic Surgery, St. Josef Hospital, Essen, Germany.
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17
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Factors related to the evolution of quality of life in patients with cervicofacial non-melanoma skin cancer. Support Care Cancer 2021; 29:5187-5195. [PMID: 33629186 DOI: 10.1007/s00520-021-06087-y] [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: 08/06/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Non-melanoma skin cancer (NMSC) is the most frequent neoplasm today, worldwide. This type of tumour presents low mortality but causes a major psychosocial impact on the patient. Studies have shown that the patient's quality of life (as detected by questionnaire scores in this respect) improves as the care process advances. The main aim of the present study is to identify the factors that are related to this favourable evolution. METHODS This descriptive cross-sectional study included patients with cervicofacial NMSC, confirmed by skin biopsy. The patients were asked to complete the Skin Cancer Index questionnaire at the time of diagnosis and subsequently at 1 week, 1 month and 6 months after treatment. Relevant demographic variables were recorded, together with information on health status and the treatment received. RESULTS A total of 229 patients with biopsy-confirmed cervicofacial NMSC were included in the study population, and 220 completed the quality of life questionnaires at the necessary time points during the care process. Some variables-sex, education, marital status, history of anxiety or depression, tumour type, the treatment received and the VAS score in this respect-were found to have a statistically significant influence on the degree of improvement recorded in the quality of life questionnaire scores during follow-up. CONCLUSIONS The quality of life questionnaire scores of patients with cervicofacial NMSC improve following treatment, but this progression is not homogeneous among patients. We identify the variables that are related to a greater degree of improvement on the questionnaire scales (overall, emotional and social-aesthetic).
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18
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Patient Satisfaction With Mohs Surgery for Melanoma In Situ. Dermatol Surg 2021; 47:288-290. [PMID: 31809345 DOI: 10.1097/dss.0000000000002281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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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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20
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Abstract
BACKGROUND The increasing burden from basal cell carcinoma (BCC) has stimulated the development of alternative treatments for these tumors. OBJECTIVE This review focuses on upcoming laser treatments for BCC and highlights the limitations of these therapies. METHODS A PUBMED search was conducted for articles on laser therapy of BCC. Key studies involving lasers to treat BCC were reviewed. Novel approaches to BCC are also described. RESULTS Vascular-specific laser therapy has increasingly been studied as an addition in the therapeutic armamentarium of BCC. Although these studies demonstrate efficacy for nonaggressive BCC, optimization of this technique is ongoing to minimize scarring. A more targeted approach to the treatment of BCC, such as immunized photothermal therapy or laser-assisted chemotherapeutic delivery, may result in less scarring, while maintaining efficacy similar to that of lasers targeting tumor vasculature. CONCLUSION Vascular-specific laser therapies show promise in treating low-risk BCC; however, scarring is not an uncommon adverse event. Although only animal studies have been performed to date, laser-activated gold nanoparticle therapy and laser-assisted drug delivery of vismodegib are potential therapies that theoretically confer a more selective approach. Laser modalities demonstrate promise in the treatment of nonaggressive BCC, although long-term studies have yet to be published.
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21
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Mazmudar RS, Fazio J, Garland K, Tripathi R, Clark M, Olasz E, Bordeaux JS, Scott JF. Predictors of patient-initiated communication after Mohs micrographic surgery: A multi-institutional prospective cohort study. J Am Acad Dermatol 2020; 85:1290-1293. [PMID: 32896594 DOI: 10.1016/j.jaad.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/20/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Rishabh S Mazmudar
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Justin Fazio
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin Garland
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Melanie Clark
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Edit Olasz
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
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22
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Shao K, Taylor L, Miller CJ, Etzkorn JR, Shin TM, Higgins HW, Giordano CN, Sobanko JF. The Natural Evolution of Facial Surgical Scars: A Retrospective Study of Physician-Assessed Scars Using the Patient and Observer Scar Assessment Scale Over Two Time Points. Facial Plast Surg Aesthet Med 2020; 23:330-338. [PMID: 32808822 DOI: 10.1089/fpsam.2020.0228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The natural evolution of facial scars has not been well described. Identifying factors that correlate with optimal scar healing may help patients and physicians during the perioperative period. Methods: A retrospective study of 108 facial skin cancer patient scars was performed. The Patient and Observer Scar Assessment Scale (POSAS) was used to grade scars at two time points (1 week and 3 months postoperatively). Paired two-tailed t-tests identified differences in scar ratings between the time points. Analysis of variance (ANOVA) explored whether POSAS scores differed by anatomic site or reconstruction type. Receiver operating characteristic analysis was performed to identify if 1-week scar appearance correlated with scar appearance at 3 months. Results: Between 1 week and 3 months the total POSAS score improved by 36.3% and overall opinion of the scar improved by 38.6% (p < 0.001). Facial cosmetic units differed in their 1-week and 3-month scores and all anatomic sites demonstrated significant improvement between time points. Differential scoring occurred among reconstruction types. Scar appearance at 1 week was able to predict overall scar appearance at the 3-month visit (area under the curve = 0.7732). Conclusions: Early scar appearance predicts later scar appearance, and scars will improve by nearly 40% 3 months after surgery. These data can be used to assist with perioperative counseling and expectation management.
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Affiliation(s)
- Kimberly Shao
- Department of Dermatology, University of Connecticut, Farmington, Connecticut, USA
| | - Lynne Taylor
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania Health System. Philadelphia, Pennsylvania, USA
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania Health System. Philadelphia, Pennsylvania, USA
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania Health System. Philadelphia, Pennsylvania, USA
| | - H William Higgins
- Department of Dermatology, University of Pennsylvania Health System. Philadelphia, Pennsylvania, USA
| | - Cerrene N Giordano
- Department of Dermatology, University of Pennsylvania Health System. Philadelphia, Pennsylvania, USA
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania Health System. Philadelphia, Pennsylvania, USA
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23
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Variation in Prescribing and Factors Associated With the Use of Prophylactic Antibiotics for Mohs Surgery: A Single-Institution Retrospective Study. Dermatol Surg 2020; 46:868-875. [DOI: 10.1097/dss.0000000000002203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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24
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Fix WC, Miller CJ, Etzkorn JR, Shin TM, Howe N, Sobanko JF. Comparison of Accuracy of Patient and Physician Scar Length Estimates Before Mohs Micrographic Surgery for Facial Skin Cancers. JAMA Netw Open 2020; 3:e200725. [PMID: 32159810 PMCID: PMC7066479 DOI: 10.1001/jamanetworkopen.2020.0725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Patients are satisfied when surgical outcomes meet their expectations. Dissatisfaction with surgical scars is one of the most common reasons that patients sue surgeons who perform Mohs micrographic surgery (MMS). OBJECTIVE To measure the accuracy of patient and physician estimations of scar length prior to skin cancer removal with MMS. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted between December 1, 2017, and February 28, 2018, at the MMS clinic of a single tertiary referral center health system. A total of 101 adults presenting for MMS for treatment of facial skin cancers volunteered for this study, and 86 surgeons who performed the MMS procedure participated. MAIN OUTCOMES AND MEASURES Patients and physicians independently drew the anticipated scar length on the patients' skin prior to surgery. Preoperative estimates by patients and surgeons were compared with actual postoperative scar length. RESULTS Of the 101 patients who participated, 57 patients (56.4%) were men and 57 patients (56.4%) were aged 65 years or older. Eighty-four patients (83.2%) underestimated scar length, whereas 67 of the 86 surgeons (77.9%) correctly estimated the scar length (P < .001). The actual postoperative scar length was 2.2 (interquartile range, 1.5-3.6) times larger than the patients' preoperative estimate but only 1.1 (interquartile range, 1.0-1.2) times larger than the surgeons' preoperative estimate (P < .001). Preoperative consultation with the surgeon, a personal history of MMS, or patient-directed research about MMS were not associated with improvement of patients' estimations of scar length. CONCLUSIONS AND RELEVANCE This study's findings suggest that patients with facial skin cancers have unrealistic expectations regarding scars that measure, on average, less than half the length of the actual postoperative scars. Surgeons appear to accurately estimate the length of most surgical scars and have an opportunity to set realistic patient expectations about scar length before surgery.
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Affiliation(s)
- William C. Fix
- Medical student at time of writing, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Jeremy R. Etzkorn
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia
| | - Thuzar M. Shin
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia
| | - Nicole Howe
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia
| | - Joseph F. Sobanko
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia
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Barbieri JS, Etzkorn JR, Margolis DJ. Use of Antibiotics for Dermatologic Procedures From 2008 to 2016. JAMA Dermatol 2020; 155:465-470. [PMID: 30825412 DOI: 10.1001/jamadermatol.2019.0152] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Although overall antibiotic use among dermatologists is decreasing, there has been an increase in use associated with dermatologic procedures during the past decade. This higher antibiotic use may increase antibiotic-associated adverse events and promote the development of antibiotic resistance. Objective To characterize antibiotic use associated with dermatologic procedures, including geographic variation. Design, Setting, and Participants Using Optum Clinformatics DataMart deidentified commercial claims data, we performed a repeated cross-sectional analysis of antibiotic prescribing by dermatologists from 2008 to 2016. Dermatology clinicians were identified by their National Uniform Claim Committee taxonomy codes, encounters for surgical procedures were identified by Common Procedure Terminology codes, and courses of oral antibiotics prescribed by these clinicians were identified by their National Drug Codes. Exposures Claims for oral antibiotic prescriptions associated with encounters with dermatologists associated with dermatologic procedures. Main Outcomes and Measures Frequency of antibiotic prescribing and associated procedures. Poisson regression models were used to assess for changes in the frequency of antibiotic prescribing over time. Results Between 2008 and 2016, among 1 934 633 encounters (1 128 244 unique patients, 854 072 [44.1%] were women and the median [interquartile range] age was 66 [52-76] years) for dermatologic procedures, oral antibiotic prescribing associated with benign excisions increased from 2.9% to 4.4% of visits (52.5% relative change; incidence rate ratio [IRR], 1.04; 95% CI, 1.03-1.04), antibiotic prescribing associated with malignant excisions increased from 4.2% to 6.3% of visits (49.5% relative change; IRR, 1.06; 95% CI, 1.05-1.06), and antibiotic prescribing associated with Mohs surgery increased from 9.9% to 13.8% of visits (39.7% relative change; IRR, 1.04; 95% CI, 1.03-1.04). There was greater than 2-fold variation in antibiotic prescribing rates across geographic census divisions. If higher prescribing divisions were to develop antibiotic prescribing rates similar to lower prescribing divisions, antibiotic use could be decreased by over 50%. Conclusions and Relevance Oral antibiotic prescribing by dermatologists associated with benign excisions, malignant excisions, and Mohs surgery is increasing over the past decade and there is substantial geographic variation. These findings highlight that there may be opportunities to optimize antibiotic use associated with dermatologic procedures.
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Affiliation(s)
- John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Associate Editor
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.,Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
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26
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Mori S, Blank NR, Connolly KL, Dusza SW, Nehal KS, Rossi AM, Lee EH. Association of Quality of Life With Surgical Excision of Early-Stage Melanoma of the Head and Neck. JAMA Dermatol 2019; 155:85-89. [PMID: 30422228 DOI: 10.1001/jamadermatol.2018.3409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Importance Surgical excision is the standard-of-care treatment for Tis and T1a melanomas of the head and neck. Currently, however, the association of diagnosis and surgical treatment of these typically slowly progressive and nonfatal melanomas with a patient's health-related quality of life (HRQoL) is unknown. Objective To characterize and assess HRQoL in patients with Tis and T1a head and neck melanoma, evaluate changes in HRQoL over the surgical treatment course, and identify patient characteristics associated with lower HRQoL. Design, Setting, and Participants This longitudinal, prospective cohort study involved patients with Tis or T1a melanoma of the head and neck who underwent staged excision at a single tertiary care center (Memorial Sloan Kettering Cancer Center, New York, New York) and were recruited from June 1, 2016, to February 28, 2017. Patients were followed up for 1 year after their surgical procedure. Participants were asked to complete 2 patient-reported outcome measure questionnaires, Skindex-16 and Skin Cancer Index (SCI), at 4 time points: baseline, perioperative (1 to 2 weeks after surgery), and 6-month and 1-year follow-up. Main Outcomes and Measures Scores on the Skindex-16 and SCI questionnaires. Results In total, 56 patients were included in the study, among whom 24 (43%) were female and 32 (57%) were male, with a mean (range) age of 67.2 (32-88) years; all patients self-identified as white. Forty-one (73%) questionnaires at perioperative, 49 (88%) at 6-month postoperative, and 41 (73%) at 1-year postoperative time points were completed. At baseline, female patients and those younger than 65 years had statistically significantly worse HRQoL on the Skindex-16 questionnaire (mean score, 14.2 [95% CI, 9.1-21.9] and 16.1 [95% CI, 9.8-26.4]) and on the SCI questionnaire (mean score, 57.2 [95% CI, 48.3-67.6] and 53.2 [95% CI, 44.1-64.3]) compared with males (mean Skindex-16 score, 7.0 [95% CI, 4.8-10.3]; mean SCI score, 73.5 [95% CI, 66.0-81.7]) and those aged 65 years or older (mean Skindex-16 score 7.1 [95% CI, 5.0-10.0]; mean SCI score, 74.3 [95% CI, 67.7-81.6]). Questions that demonstrated the worst scores at baseline were worry about skin condition (Skindex-16) and worry about future skin cancers (SCI). The emotions subscale scores on the Skindex-16 questionnaire showed the greatest improvement from baseline to 1-year follow-up levels (26.6 vs 15.3; P < .001) and so did the appearance subscale scores on the SCI questionnaire (64.0 vs 84.6; P < .001). The score difference in HRQoL by sex diminished over time, whereas the score difference by age persisted through the first year. Conclusions and Relevance Improvement in HRQoL at the 6-month and 1-year follow-up was associated with surgical excision in patients with early-stage head and neck melanoma, and younger and female patients experienced worse HRQoL. These results may be used in tailoring counseling for this patient population.
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Affiliation(s)
- Shoko Mori
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,State University of New York Downstate College of Medicine, Brooklyn, New York
| | - Nina R Blank
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen L Connolly
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Sanchez N, Griggs J, Nanda S, Fayne R, Castillo D, De Bedout V, Meirson D, Nichols A. The Skin Cancer Index: quality-of-life outcomes of treatments for nonmelanoma skin cancer. J DERMATOL TREAT 2019; 31:491-493. [PMID: 31566077 DOI: 10.1080/09546634.2019.1674772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Non-melanoma skin cancers (NMSCs) are the most common malignancies in humans. When treating NMSC, quality-of-life (QOL) is an important consideration. The purpose of this study was to measure and compare QOL outcomes of two common therapies for NMSC: Mohs micrographic surgery and excision, using a disease-specific QOL instrument, the Skin Cancer Index (SCI).Methods: The University of Miami Institutional Review Board approved this retrospective chart review of patients diagnosed with NMSC from 2016 through 2019 at a private dermatology clinic (Deerfield Beach, FL, USA). Disease-specific QOL before and after surgery was measured with the SCI.Results: Pre- and post-surgery surveys were completed by 208 patients undergoing Mohs surgery and 30 patients undergoing excisional surgery. All patients were similar in age, gender, and race, and most patients undergoing either procedure had a history of additional prior skin cancers. For the Mohs cohort, the total SCI scores and each of the subscales were significantly higher post-surgery when compared with the baseline scores. In contrast, in the excision cohort, the social subscale was significantly lower post-surgery when compared with the baseline scores.Conclusion: There is limited data in the literature describing the specific effects of Mohs or excision for NMSC on QOL using a disease-specific QOL instrument. Our data supports increased QOL at 2-week follow up for patients with NMSC treated with Mohs, but no improvement in QOL was noted for patients treated with excision. This data is limited by the fact there were far more patients that underwent Mohs as opposed to excision, which gave the Mohs cohort greater statistical power when analyzing the difference in SCI.
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Affiliation(s)
- Nelson Sanchez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jacob Griggs
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonali Nanda
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rachel Fayne
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David Castillo
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Valeria De Bedout
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dan Meirson
- Meirson Dermatology, Deerfield Beach, FL, USA
| | - Anna Nichols
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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28
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Patient Scar Assessment Correlates With Quality of Life After Mohs Micrographic Surgery. Dermatol Surg 2019; 46:1745-1747. [PMID: 31592916 DOI: 10.1097/dss.0000000000002183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Vaidya TS, Mori S, Dusza SW, Rossi AM, Nehal KS, Lee EH. Appearance-related psychosocial distress following facial skin cancer surgery using the FACE-Q Skin Cancer. Arch Dermatol Res 2019; 311:691-696. [PMID: 31338583 DOI: 10.1007/s00403-019-01957-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 07/13/2019] [Indexed: 01/21/2023]
Abstract
Over 2 million facial skin cancers occur globally each year. Facial skin cancer surgery can leave scars that may alter appearance and impact psychosocial functioning. The objective of this study is to assess patient-reported appearance-related psychosocial distress following facial skin cancer surgery, and to identify independent predictors of psychosocial impairment. This was a single-center, cross-sectional study at a tertiary care cancer center including patients who underwent dermatologic surgery on the face from March 1, 2016 to March 31, 2018. Patients completed the FACE-Q Skin Cancer Appearance-related Psychosocial Distress scale postoperatively between May 21, 2018 and October 1, 2018. Patient responses were rated on a 4-point Likert scale and converted on a scale from 0 to 100. In total, 359 patients completed the questionnaire (34.2% response rate). Overall, patients reported a low level of psychosocial distress. Patients most frequently reported items of self-consciousness, unhappiness, and insecurity < 3 months following surgery. Though psychosocial distress significantly improved over time, self-consciousness continued to be reported in the long-term postoperative period. Linear regression analysis determined that younger age, history of anxiety and/or depression, surgery on the nose, and repair by flap were independently predictive of psychosocial distress. Marginal predicted values for distress scores based on age demonstrated an indirect relationship. Patient-reported appearance-related psychosocial distress is low following facial skin cancer surgery, and report of distress decreases over time. The identified predictors of distress may be used as indicators for offering psycho-oncologic support and early interventions to improve scar appearance.
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Affiliation(s)
- Toral S Vaidya
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 E. 60th Street, New York, NY, 10022, USA
| | - Shoko Mori
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 E. 60th Street, New York, NY, 10022, USA
| | - Stephen W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 E. 60th Street, New York, NY, 10022, USA
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 E. 60th Street, New York, NY, 10022, USA
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 E. 60th Street, New York, NY, 10022, USA
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 E. 60th Street, New York, NY, 10022, USA.
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30
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Venning VL, Moreno-Bonilla G, Stewart TJ, Lee S, Fernandez-Peñas P. Increased collaboration between Mohs and plastic surgeons in the surgical management of skin cancer in Australia. Australas J Dermatol 2019; 61:85-87. [PMID: 31292946 DOI: 10.1111/ajd.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Victoria L Venning
- The Skin Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Gilberto Moreno-Bonilla
- The Skin Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Thomas J Stewart
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Simon Lee
- The Skin Hospital, Sydney, NSW, Australia
| | - Pablo Fernandez-Peñas
- The Skin Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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31
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Lee MP, Zullo SW, Sobanko JF, Etzkorn JR. Patient-Centered Care in Dermatologic Surgery: Practical Strategies to Improve the Patient Experience and Visit Satisfaction. Dermatol Clin 2019; 37:367-374. [PMID: 31084730 DOI: 10.1016/j.det.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patient-centered care in dermatologic surgery emphasizes addressing the preferences, values, and concerns of the surgical patient in an effort to improve the overall experience. Impediments affecting the delivery of Mohs micrographic surgical treatment of skin cancers are present throughout the perioperative period. Defining actionable strategies to improve outcomes can be challenging due to sparse literature and minimal high-quality scientific studies. This review focuses on the current evidence supporting practical recommendations in each surgical setting to improve the patient experience and increase visit satisfaction.
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Affiliation(s)
- Michael P Lee
- Department of Dermatology, University of Pennsylvania, 3400 Civic Center Boulevard, Suite 1-330S, Philadelphia, PA 19104, USA.
| | - Shannon W Zullo
- Department of Dermatology, University of Pennsylvania, 3400 Civic Center Boulevard, Suite 1-330S, Philadelphia, PA 19104, USA
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, 3400 Civic Center Boulevard, Suite 1-330S, Philadelphia, PA 19104, USA
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania, 3400 Civic Center Boulevard, Suite 1-330S, Philadelphia, PA 19104, USA
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32
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Mori S, Lee E. Beyond the physician's perspective: A review of patient-reported outcomes in dermatologic surgery and cosmetic dermatology. Int J Womens Dermatol 2019; 5:21-26. [PMID: 30809575 PMCID: PMC6374698 DOI: 10.1016/j.ijwd.2018.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 12/26/2022] Open
Abstract
Patient-reported outcome measures (PROMs) are utilized in health care to quantify the patient's perspective of a health condition or treatment on outcomes, such as health-related quality of life (HRQoL) and patient satisfaction. In dermatology, this is particularly relevant because the patient's perspective is critical in evaluating the outcome of cosmetic procedures as well as skin cancer treatment. We review seven validated PROMs that have been reported in the dermatologic surgery and cosmetic dermatology literature. For patients undergoing cosmetic procedures, the use of PROMs provides additional valuable outcome data beyond physician assessment. For patients with skin cancer, women experience a unique and often greater impact on HRQoL during treatment, which has been captured through PROMs. The recent development of multi-module instruments, such as the FACE-Q and FACE-Q Skin Cancer, have facilitated comprehensive assessments of treatment that impact multiple domains of HRQoL. The use of PROMs allows for dermatologists to reliably capture important disease- and treatment-related concerns, thus improving the patient experience.
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Affiliation(s)
| | - E.H. Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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33
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Commentary on Patients' Body Image Improves After Mohs Micrographic Surgery for Nonmelanoma Head and Neck Skin Cancer. Dermatol Surg 2018; 44:1389-1390. [PMID: 30303823 DOI: 10.1097/dss.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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