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Yarahmadi S, Soleimani M, Gholami M, Fakhr-Movahedi A, Madani SMS. Ageism and lookism as stereotypes of health disparity in intensive care units in Iran: a critical ethnography. Int J Equity Health 2024; 23:114. [PMID: 38831276 PMCID: PMC11149295 DOI: 10.1186/s12939-024-02180-w] [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: 08/22/2023] [Accepted: 04/17/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The intensive care unit presents structural complexities, and the prevailing power imbalance between patients and staff can lead to health disparities. Hence, unveiling the underlying factors that give rise to and reinforce these disparities can contribute to their prevention. This study aims to shed light on the stereotypes linked to ageism and lookism, which perpetuate health disparities within the intensive care unit setting in Iran. METHODS This critical ethnographic study employed Carsepkan's approach and was carried out in intensive care units in the west of Iran from 2022 to 2023. The data collection and analysis were conducted through three interconnected stages. In the initial stage, more than 300 h of observations were made at the research site. In the subsequent stage, a horizon analysis was performed. Conversations with 14 informants were conducted in the final stage to enrich the dataset further. Then the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity. To verify the validity and reliability of the study, credibility, conformability, dependability, and transferability were all taken into account. FINDINGS The ageism and lookism stereotypes emerged from seven main themes; youth-centric; negative ageism; age-friendliness; age-related priority; centered care for pediatric patients and families; appearance-centeredness; and a contradiction between belief and behavior. CONCLUSION This critical study showed that ageism and lookism stereotypes permeated the intensive care unit's culture. These stereotypes have the potential to influence equality dynamics, as well as to foster and support health disparity in the intensive care unit.
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Affiliation(s)
- Sajad Yarahmadi
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohsen Soleimani
- Nursing Care Research Center, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
| | - Mohammad Gholami
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Fakhr-Movahedi
- Nursing Care Research Center, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
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Sciegienka S, Slijepcevic A, Lipsey K, Spataro E, Chen C. Time to Mohs Reconstruction: A Systematic Review Comparing Complication Rates between Immediate and Delayed Repair. Facial Plast Surg 2024; 40:370-377. [PMID: 37336502 DOI: 10.1055/a-2112-7073] [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: 06/21/2023] Open
Abstract
Several known factors affect outcomes of Mohs facial defect reconstruction; however, the effect of repair timing on outcomes is ill-defined. The aim of this study was to determine postoperative complication rates between immediate and delayed repair of Mohs facial defects. Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were used. Articles were selected using PICO format-population: Mohs facial defect patients, intervention: defect repair, comparator: immediate (<24 hours), or delayed (>24 hours) repair, outcome: complication rate. PubMed/Medline (1946-2020), EMBASE (1947-2020), Scopus (1823-2020), Web of Science (1900-2020), Cochrane Library, and Clinicaltrials.gov were searched. Two independent reviewers screened abstracts; those in English with human subjects reporting repair timing and complication rates were included. Search criteria yielded 6,649 abstracts; 233 qualified for review. Data were gathered from six studies; they alone contained comparative data meeting inclusion criteria. While many well-written studies were encountered, reported results varied widely. A statistically sound meta-analysis could not be completed due to large heterogeneity between studies, biasing the analysis towards the largest weighted study. Clinically important differences may exist between immediate and delayed Mohs reconstruction, but small study numbers, large heterogeneity, and lack of standardized outcome measures limit definitive conclusions. More studies are needed to perform appropriate meta-analyses, including studies using standardized methods of reporting Mohs outcome data.
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Affiliation(s)
- Sebastian Sciegienka
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri
| | - Allison Slijepcevic
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kim Lipsey
- Bernard Becker Medical Library, Washington University in St. Louis, St Louis, Missouri
| | - Emily Spataro
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - Collin Chen
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St Louis, Missouri
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Kučinskaitė A, Stundys D, Gervickaitė S, Tarutytė G, Grigaitienė J, Tutkuvienė J, Jančorienė L. Aesthetic Evaluation of Facial Scars in Patients Undergoing Surgery for Basal Cell Carcinoma: A Prospective Longitudinal Pilot Study and Validation of POSAS 2.0 in the Lithuanian Language. Cancers (Basel) 2024; 16:2091. [PMID: 38893210 PMCID: PMC11171257 DOI: 10.3390/cancers16112091] [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: 04/17/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Facial basal cell carcinoma (BCC) surgery enhances the quality of life (QoL) but leaves patients with inferior QoL, presumably caused by scarring, emphasizing the need to understand post-surgery aesthetic satisfaction. This study aimed to validate the Lithuanian version of the Patient and Observer Scar Assessment Scale (POSAS) 2.0 and utilise it to identify scar evaluation differences and correlations among POSAS scores and specific aesthetic facial regions, age, gender, surgery types, and short- and long-term QoL. Employing a prospective longitudinal design, 100 patients with facial scars after surgical BCC removal were enrolled. The validation phase confirmed the translated POSAS 2.0 psychometric properties, while the pilot phase used statistical analyses to compare scores among demographic and clinical groups and evaluate correlations between scar assessment and QoL. The findings indicate that the translated Lithuanian version of POSAS 2.0 exhibits good psychometric properties, revealing insights into aesthetic satisfaction with post-surgical facial scars and their impact on QoL. The Lithuanian version of the POSAS 2.0 was established as a valid instrument for measuring post-surgical linear scars. QoL with scar assessment statistically significantly correlates, 6 months after surgery, with worse scores, particularly notable among women, younger patients, and those with tumours in the cheek region.
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Affiliation(s)
| | - Domantas Stundys
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
| | - Simona Gervickaitė
- Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (S.G.); (J.T.)
| | - Gabrielė Tarutytė
- Department of Research and Innovation, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
- Institute of Applied Mathematics, Faculty of Mathematics and Informatics, Vilnius University, 03225 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Jūratė Grigaitienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
| | - Janina Tutkuvienė
- Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (S.G.); (J.T.)
| | - Ligita Jančorienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
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De Henau M, van Kuijk SM, Colla C, Van den Kerckhove E, Van der Hulst RR, Piatkowski A. Pressure Masks for Facial Scar Treatment after Oncological Reconstruction: Long-Term Patient Satisfaction and Quality of Life. Facial Plast Surg 2024; 40:36-45. [PMID: 36787790 PMCID: PMC10774008 DOI: 10.1055/a-2035-4468] [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: 02/16/2023] Open
Abstract
INTRODUCTION With increasing incidence of facial skin cancer, more patients undergo facial reconstruction following Mohs micrographic surgery (MMS). Aesthetically unpleasing, thickened facial flaps, and disturbing scars can be treated with a pressure mask with inner silicone lining to help improve functional and aesthetic outcomes. However, data on long-term patient satisfaction and quality of life (QoL) following this treatment are lacking. METHODS We aimed to assess long-term satisfaction and QoL of patients who underwent local flap reconstruction following MMS. Patients treated between January 2012 and October 2020 were invited to answer FACE-Q and SCAR-Q questionnaires. Demographic data, skin cancer type and location, type of reconstruction, postoperative complications, duration of pressure mask therapy, daily compliance, and additional scar treatment were collected to explore possible predictors. RESULTS Of 92 eligible patients, 50 responded. Eighteen respondents were male (36%) and 32 were female (64%). Mean duration of pressure mask therapy was 10.20 ± 4.61 months. Patients were 61.14 ± 32.91 months after completion of pressure mask therapy upon participation. Patients whose reconstruction consisted of multiple flaps had significantly worse outcomes in social function (p = 0.012), scar appearance (p = 0.045), and scar symptoms (p = 0.008). A trend of increasing time since therapy completion predicting better outcomes was observed for all scales, and it was a significant predictor for better scar appearance (p = 0.001) and less scar symptoms (p = 0.001). CONCLUSION Pressure mask treatment for facial flaps and scars following MMS results in good long-term patient satisfaction and QoL. Multiple local flaps, reflecting a larger skin defect postexcision, is a predictor for worse outcomes in social function, scar appearance, and symptoms. Increasing time is associated with increasing satisfaction, which reflects satisfactory and stable long-term effects of treatment, possibly combined with more acceptance of the result over time.
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Affiliation(s)
- Melissa De Henau
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School of Oncology and Reproduction, Maastricht University, the Netherlands
| | - Sander M.J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carlo Colla
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric Van den Kerckhove
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Rehabilitation Sciences, Faber, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation and Burns Center, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Rene R.W.J. Van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Plastic Surgery, VieCuri Medical Centrum, Venlo, the Netherlands
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Bandopadhyay A, Kapoor A, Kundu K, Jagtap M, Chattopadhyay D. Translation and validation of Hindi version of patient scar assessment scale in patients with postburn facial scar. J Cutan Aesthet Surg 2024; 17:55-59. [PMID: 38736860 PMCID: PMC11086925 DOI: 10.4103/jcas.jcas_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Patient scar assessment scale (PSAS) is a reliable and standard tool for assessment of scars by the observer and the patient. Till now the scale has not been translated to Hindi. The objective of the study was to translate and validate the PSAS to Hindi. Materials and Methods We did forward and backward translation of the English PSAS together with its validation. In total, 64 patients with postburn facial scars were included. The validation committee consisted of 6 bilingual members. Results The PSAS-Hindi showed good internal consistency with Cronbach's α of 0.86. Test-retest reliability showed good correlation with intra class coefficient being 0.94 (95% confidence interval: 0.83-0.97). Conclusion The PSAS was successfully translated to Hindi, and cross-cultural adaptation was made.
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Affiliation(s)
- Arkapal Bandopadhyay
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akshay Kapoor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kaustav Kundu
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manish Jagtap
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debarati Chattopadhyay
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Manoharan D, Thompson KG, Gage D, Scott JF. An organizational framework for patient-reported outcome instruments in dermatologic surgery: a systematic review and qualitative analysis. Arch Dermatol Res 2023; 316:15. [PMID: 38047921 DOI: 10.1007/s00403-023-02738-8] [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: 04/30/2023] [Revised: 04/30/2023] [Accepted: 09/16/2023] [Indexed: 12/05/2023]
Abstract
Patient-reported outcomes (PROs) describe measures of a patient's experience throughout medical care as reported by the patient (Mercieca-Bebber et al. in Patient Relat Outcome Meas, 2018). Various PRO instruments exist. It is challenging to select appropriate instruments given the absence of an organizational framework which describes all measurable PROs in dermatologic surgery and represents which instruments measure which outcomes. Our objective was to systematically review all validated PRO instruments in dermatologic surgery and use qualitative analysis to develop an organizational framework representing PRO measures and instruments. PubMed/MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane databases were searched to retrieve validated PRO instruments in the dermatologic surgery population. The constant comparative method of qualitative analysis was used to develop an organizational framework representing all PROs in dermatologic surgery. All instruments were sorted into this framework. The search identified 3195 articles; 35 validated instruments were extracted and qualitatively analyzed. The organizational framework sorted all instruments into 36 PRO measures aligned with the National Institutes of Health Patient-Reported Outcomes Measurement Information System (Gershon RC, Rothrock N, Hanrahan R, et al (2010) The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research). Measures were grouped into four categories (expectations, satisfaction, quality of life, needs) describing how patients experience these outcomes and lenses through which researchers can evaluate them. In conclusion, we have proposed an organizational framework for use in choosing validated instruments to develop and answer PRO research questions.
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Affiliation(s)
- Divya Manoharan
- Department of Dermatology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21287, USA.
| | - Katherine G Thompson
- Department of Dermatology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21287, USA
| | - Davies Gage
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21287, USA
- Clinical Skin Center of Northern Virginia, Fairfax, VA, USA
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Catalan-Griffiths A, Pasquali P, Arias-Santiago S, Valeron P, Martinez-Lopez A, Negrin ML, Thuissard Vasallo IJ, Andreu-Vazquez C, Freites-Martinez A. Shared decision-making quality and decisional regret in patients with low-risk superficial basal cell carcinoma: A prospective, multicenter cohort study. JAAD Int 2023; 13:159-163. [PMID: 37823045 PMCID: PMC10562145 DOI: 10.1016/j.jdin.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 10/13/2023] Open
Abstract
Background Many therapies are available to treat low-risk superficial basal cell carcinoma (lr-sBCC), which may complicate the shared decision-making (SDM) process. Objective To assess the SDM process of patients and physicians when deciding lr-sBCC therapy as well as the factors that may influence the SDM process. Methods A prospective, multicenter cohort study was conducted over 18 months, from October 2018 to April 2020, in 3 tertiary university hospitals and 1 private hospital. Results This study included 107 patients. There was a weak positive correlation between Shared Decision-Making Questionnaire-Patient version (SDM-Q-9) and Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) (Spearman's correlation coefficient [rs] [105] = 0.21; P = .03). Most patients (71%) chose a nonsurgical treatment after the SDM process. Patients with higher satisfaction with the SDM had lower decisional conflict and decisional regret (P < .001). Patients aged >80 years had higher rates of significant decisional conflict. When evaluating treatment decisions, the highest median score for decisional conflict (22, IQR [16]; P = .01) was observed among patients who chose a surgical excision. Limitations Patients may have self-selected to participate. Conclusion This study suggests that some patients may prefer less invasive therapies for lr-sBCC. The SDM process may reduce decisional conflict and decisional regret.
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Affiliation(s)
- Andrea Catalan-Griffiths
- Dermatology Service, Medical University of Graz, Graz, Austria / AUVA Rehabilitation Clinic Tobelbad, Tobelbad, Austria
| | - Paola Pasquali
- Dermatology Service, Pius de Valls Hospital, Tarragona, Spain / Alcala University
| | - Salvador Arias-Santiago
- Dermatology Service, Virgen de las Nieves University Hospital, Granada, Spain
- Biosanitary Research Institute of Granada - ibs.GRANADA, Granada, Spain
| | - Pedro Valeron
- Dermatology Service, Dr Negrin University Hospital, Gran Canaria, Spain
| | | | | | | | | | - Azael Freites-Martinez
- Dermatology Service, Hospital Ruber Juan Bravo Hospital / Universidad Europea, Madrid, Spain
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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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Greif T, Alsawas M, Reid AT, Liu V, Prokop L, Murad MH, Powers JG. Targeting the Angiotensin Pathway in the Treatment of Cutaneous Fibrosis: A Systematic Review. JID INNOVATIONS 2023; 3:100231. [PMID: 37840767 PMCID: PMC10568560 DOI: 10.1016/j.xjidi.2023.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 10/17/2023] Open
Abstract
Acting on the renin-angiotensin-aldosterone system, angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are mechanisms of some of the most prescribed medications in the world. In addition to their routine use for the treatment of hypertension, such agents have gained attention for their influence on the angiotensin receptor pathway in fibrotic skin disorders, including scars and keloids. To evaluate the current level of evidence supporting the use of these agents, a systematic review related to ACE-Is/ARBs and cutaneous scarring was conducted. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from database inception through January 26, 2022. Two independent reviewers identified eligible studies for inclusion and extracted data. Data were insufficient for meta-analysis and are presented narratively. Of 461 citations identified, seven studies were included (199 patients). The studies included two randomized clinical trials, one comparative observation study, and four case reports. All the included studies reported statistically significant improvement in cutaneous scarring in patients using ACE-Is/ARBs compared with that in those treated with placebo/control using various outcome measures such as scar size and scar scales. However, much of the literature on this subject to date is limited by study design.
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Affiliation(s)
- Trenton Greif
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Mouaz Alsawas
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander T. Reid
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Vincent Liu
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - M. Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer G. Powers
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Safi S, Ahmadzade M, Karimi S, Akbari ME, Rouientan H, Abolhosseini M, Rezaei Kanavi M, Khorrami Z. A registration trend in eyelid skin cancers and associated risk factors in Iran, 2005-2016. BMC Cancer 2023; 23:924. [PMID: 37777736 PMCID: PMC10543867 DOI: 10.1186/s12885-023-11414-z] [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: 06/04/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Eyelid skin cancers are the most prevalent ophthalmic malignancies. This study aimed to evaluate the association of the Human Development Index (HDI) and lifestyle risk factors with eyelid skin cancers in Iran. METHODS This ecological study analyzed the data collected from the Iranian National Population-based Cancer Registry (2005-2016). The data on provincial-level eyelid skin cancer risk factors were obtained from national sources. The association between provincial HDI and lifestyle risk factors with the prevalence of eyelid skin cancers was assessed. RESULTS The mean 12-year age-standardized incidence rate (ASIR) of eyelid skin cancers was 16.22 per 100,000 (9,104 cases). The overall ASIR showed an upward trend with an estimated annual average increase of 0.006 per year. There were positive correlations between the prevalence of overall eyelid skin cancers and provincial HDI, smoking, and obesity (r = 0.32, 0.42, and 0.37, respectively). In multivariate analysis, obesity/overweight remained a positive predictor for high prevalence of total eyelid skin cancers (OR = 1.97, 95%CI = 1.08-3.58, P = 0.026), carcinoma (2.10, 1.15-3.83, P = 0.015), and basal cell carcinoma (1.48, 0.99-2.20, P = 0.054). CONCLUSIONS An increasing trend in ASIR of eyelid skin cancers was observed in more than a decade in Iran which was positively associated with provincial HDI and prevalence of obesity. The findings of the study highlight the importance of promotional programs for preventing obesity/overweight and appropriate allocation of screening facilities based on the HDI level.
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Affiliation(s)
- Sare Safi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Rouientan
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abolhosseini
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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11
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Tan A, Castner NB, Slutsky JB. Mohs Surgeons Dominate Cutaneous Reconstructions in Cosmetically and Functionally Sensitive Sites: Medicare Trends From 2013 to 2019. Dermatol Surg 2023; 49:539-543. [PMID: 37000985 DOI: 10.1097/dss.0000000000003787] [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: 04/03/2023]
Abstract
BACKGROUND Although dermatologists perform more cutaneous reconstructions than any other specialists for the Medicare population, the perception of dermatologists as surgeons may not be as fully recognized. Mohs surgeons are trained in complex reconstructions of cosmetically and functionally sensitive (CFS) sites, although the proportion they account for is unknown. OBJECTIVE To quantify the proportion of cutaneous reconstructions in CFS sites performed by Mohs surgeons compared with other specialists, and to identify trends from 2013 to 2019. METHODS A cross-sectional analysis was performed using the Medicare Public Use Files for 2013 to 2019. Data were stratified by physician specialty, with dermatologists further subdivided into Mohs surgeons and non-Mohs dermatologists. RESULTS Mohs surgeons performed 75.3% of all reconstructions in 2019, a significant increase from 2013 ( p < .0001). Mohs surgeons dominated nearly every type of CFS cutaneous reconstruction, with significant increases in proportion ( p < .0001) from 2013 to 2019 for every category except interpolation flaps. Complex repairs were the most commonly performed cutaneous reconstruction type. CONCLUSION Mohs surgeons perform far more cutaneous reconstructive surgeries in CFS sites than any other specialty for the Medicare population, with significant increases in their lead over the study period.
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Affiliation(s)
- Andrea Tan
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, New York
| | - Nicholas B Castner
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jordan B Slutsky
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, New York
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12
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Qualitative Investigation of Experience and Quality of Life in Patients Treated with Calcium Electroporation for Cutaneous Metastases. Cancers (Basel) 2023; 15:cancers15030599. [PMID: 36765556 PMCID: PMC9913084 DOI: 10.3390/cancers15030599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
(1) Background: Calcium electroporation is a novel cancer treatment. It includes injecting calcium-solution and applying electric pulses to tumour tissue. Data on quality of life for patients with cutaneous metastases treated with calcium electroporation is limited. We evaluated quality of life in patients with skin metastases treated with calcium electroporation using qualitative interviews. (2) Methods: This investigation featured a subgroup from a non-randomised phase II study (CaEP-R) at Zealand University Hospital, Denmark, studying response to calcium electroporation in cutaneous metastasis (ClinicalTrials no. NCT04225767). Participants were interviewed at baseline before calcium electroporation treatment and after two months. Data was analysed phenomenologically; (3) Results: Interviews were conducted February 2020-November 2021. Nine patients were included, of which seven participated in both interviews. All seven patients expected treated tumours to disappear, symptom relief and minimal side effects. Most patients requested peer accounts. All patients found the treatment uncomfortable but acceptable; all thought their fears of electric pulses exceeded their experience. All would repeat the treatment if effective. Successful treatment had a positive effect on pain, symptomatic wounds, sleep, vigour and social inclination; (4) Conclusions: Calcium electroporation enhanced health-related quality of life by reducing symptoms and increasing social inclination. Peer accounts provide patients with a shortcut to confidence in treatment on top of doctors' recommendations.
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13
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Ramachandran V, Phan K. Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database. J Plast Reconstr Aesthet Surg 2022; 75:4410-4415. [PMID: 36257889 DOI: 10.1016/j.bjps.2022.08.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/18/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma. METHODS A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies. RESULTS A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan-Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P = 0.662) and cancer-specific survival (P = 0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310-2.747; P = 0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047-5.711; P = 0.591) when patients who underwent MMS were compared to those who underwent WLE. CONCLUSION While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach.
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Affiliation(s)
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, Sydney, Australia
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14
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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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15
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Hooiveld-Noeken JS, Eggen AC, Rácz E, de Vries EG, Reyners AK, Jalving M. Towards less mutilating treatments in patients with advanced non-melanoma skin cancers by earlier use of immune checkpoint inhibitors. Crit Rev Oncol Hematol 2022; 180:103855. [DOI: 10.1016/j.critrevonc.2022.103855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 11/24/2022] Open
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16
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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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17
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Sarwer DB, Siminoff LA, Gardiner HM, Spitzer JC. The psychosocial burden of visible disfigurement following traumatic injury. Front Psychol 2022; 13:979574. [PMID: 36110275 PMCID: PMC9468754 DOI: 10.3389/fpsyg.2022.979574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 12/15/2022] Open
Abstract
Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.
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Affiliation(s)
- David B. Sarwer
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
- *Correspondence: David B. Sarwer,
| | - Laura A. Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Heather M. Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
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18
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Long J, Rajabi-Estarabadi A, Levin A, Nami N, Nouri K. Perioperative Anxiety Associated With Mohs Micrographic Surgery: A Survey-Based Study. Dermatol Surg 2022; 48:711-715. [PMID: 35438652 DOI: 10.1097/dss.0000000000003455] [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: 11/25/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS)-associated anxiety is an important issue that remains poorly discussed. Identifying risk factors for MMS-associated anxiety will better equip physicians to manage patients' preoperative anxiety and result in improved patient satisfaction and outcomes. OBJECTIVE This study aims in identification of risk factors that may play a role in MMS-associated anxiety among patients with nonmelanoma skin cancer. METHODS A cross-sectional case series was conducted among MMS patients collect information on patient demographics and surgical locations and to measure perioperative anxiety and quality of life (QoL). In addition, adjusted linear and logistic regression analyses were performed to identify potential risk factors that predict MMS-associated anxiety. RESULTS Significant increases in perioperative anxiety were associated with the eyelid area compared with the noneyelid facial area and nonfacial area ( p ≤ .05). Patients with graduate degrees exhibited less anxiety compared with ones who received less education ( p ≤ .05). Higher perioperative anxiety was associated with a greater impact on QoL ( p ≤ .05). CONCLUSION This study identified that surgical location and the patient's educational level are 2 critical predicting factors for perioperative anxiety. Furthermore, perioperative anxiety could negatively affect a patient's quality of life and warrants further investigation into effective management.
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Affiliation(s)
- Jun Long
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Rajabi-Estarabadi
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Department of Dermatology, Broward Health, Fort Lauderdale, Florida; and
| | - Adam Levin
- Island Dermatology, Newport Beach, California
| | - Navid Nami
- Island Dermatology, Newport Beach, California
| | - Keyvan Nouri
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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19
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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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20
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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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21
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Dobbs TD, Harrison CJ, Ottenhof MJ, Gibson JAG, Matin RN, Rodrigues JN, Hutchings HA, Whitaker IS. Construct validity of the anglicised FACE-Q skin cancer module. J Plast Reconstr Aesthet Surg 2021; 75:1644-1652. [PMID: 34955401 DOI: 10.1016/j.bjps.2021.11.093] [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: 03/30/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The FACE-Q Skin Cancer module is a patient-reported outcome measure (PROM) for facial skin cancer. It has been anglicised for the UK population and undergone psychometric testing using classical test theory. In this study, further evaluation of construct validity using Rasch measurement theory and hypothesis testing was performed. METHODS Patients were prospectively recruited to the Patient-Reported Outcome Measures In Skin Cancer Reconstruction (PROMISCR) study and asked to complete the anglicised FACE-Q Skin Cancer module. The scalability and unidimensionality of the data were assessed with a Mokken analysis prior to Rasch analysis. Response thresholds, targeting, fit statistics, local dependency, and internal consistency were examined for all items and subscales. Four a priori hypotheses were tested to evaluate the convergent and divergent validity. We additionally hypothesised that the median 'cancer worry' score would be lower in post-operative than pre-operative patients. RESULTS 239 patients self-completed the questionnaire between August 2017 and May 2019. Of the ten subscales assessed, five showed relative fit to the Rasch model. Unidimensionality was present for all five subscales, with most demonstrating ordered item thresholds and appropriate fit statistics. Two items in the 'cancer worry' subscale had either disordered or very close response thresholds. Subscales of the FACE-Q Skin Cancer module demonstrated convergent and divergent validity with relevant Skin Cancer Index comparators (p < 0.001). Median 'cancer worry' was lower in post-operative patients (44 vs 39, p < 0.001). CONCLUSION The anglicised FACE-Q Skin Cancer module shows psychometric validity through hypothesis testing, and both classical and modern test theory.
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Affiliation(s)
- T D Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK.
| | - C J Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M J Ottenhof
- Patient-Reported Outcomes, Value and Experience (PROVE) Centre, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - J A G Gibson
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - R N Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J N Rodrigues
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - H A Hutchings
- Patient & Population Health & Informatics Research Group, Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
| | - I S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
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22
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Toman J, Michael GM, Wisco OJ, Adams JR, Hubbs BS. Mohs Defect Repair with Dehydrated Human Amnion/Chorion Membrane. Facial Plast Surg Aesthet Med 2021; 24:48-53. [PMID: 34714143 PMCID: PMC8783622 DOI: 10.1089/fpsam.2021.0167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Importance: Reconstructing cosmetically sensitive defects in an aging population undergoing multiple Mohs micrographic surgeries (MMS) may be addressed with alternatives to surgery. Objective: Patients undergoing MMS with defect reconstruction in visually prominent areas receiving placental allograft were compared with traditional autologous tissue-based procedures—flaps and full-thickness skin grafts (FTSG). Design, Setting, and Participants: This retrospective case–control study evaluated patients who underwent MMS for removal of a basal or squamous cell carcinoma with same-day repair. Main Outcomes and Measures: The primary endpoint was the incidence and comparison of postoperative morbidity. Risk for developing medical or cosmetic sequelae was determined through multivariate logistic regression. Results: The study population consisted of 143 propensity score-matched pairs (n = 286) with moderate- to high-risk defects on the face, head, and neck. Compared with autologous tissue, placental allograft cases were associated with significantly lower risk for infection (p = 0.004), poor scar cosmesis (p < 0.0001), scar revision (p < 0.0001), or reoperation (p = 0.0007). Conclusions and Relevance: Postoperative complication rates for placental reconstructions did not exceed those demonstrated by autologous tissue counterparts, indicating this is a safe alternative to flap and FTSG in cosmetically sensitive repairs.
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Affiliation(s)
- Julia Toman
- Division of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Georgina M Michael
- Department of Clinical Research, MiMedx Group, Inc., Marietta, Georgia, USA
| | - Oliver J Wisco
- Dermatology Health Specialists, Bend, Oregon, USA.,Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John R Adams
- Advanced Dermatology and Skin Cancer Center, Manhattan, Kansas, USA.,Division of Dermatology, Department of Internal Medicine, University of Kansas School of Medicine, Wichita, Kansas, USA
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23
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High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years-single institution experience. Clin Transl Oncol 2021; 24:578-585. [PMID: 34698997 PMCID: PMC8885494 DOI: 10.1007/s12094-021-02718-2] [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: 08/10/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022]
Abstract
Purpose Our center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients. Methods/patients We planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold. Results Seventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2. Conclusions High-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.
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24
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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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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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Saleh K, Ingvar Å, Kappelin J, Persson C, Lundqvist K, Ahnlide I, Persson B. Agreement between patients and surgeons on assessments of the cosmetic outcomes of Mohs micrographic surgery: Results of a single-center blinded prospective study. JAAD Int 2021; 5:52-53. [PMID: 34467241 PMCID: PMC8383098 DOI: 10.1016/j.jdin.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Karim Saleh
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Åsa Ingvar
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johan Kappelin
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Helsingborg Hospital, Helsingborg, Sweden
| | - Christina Persson
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Lundqvist
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ingela Ahnlide
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Bertil Persson
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
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27
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Bittner GC, Kubo EM, Fantini BDC, Cerci FB. Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases. An Bras Dermatol 2021; 96:408-415. [PMID: 34090728 PMCID: PMC8245722 DOI: 10.1016/j.abd.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 01/07/2023] Open
Abstract
Background The ear is a region that has a high prevalence of cutaneous carcinomas and several guidelines indicate Mohs micrographic surgery as the first-choice treatment in such cases. Although the technique allows maximum preservation of healthy tissue, many auricular surgical wounds constitute a challenge due to the peculiar local anatomy, with evident curves and reliefs. Auricular reconstruction should prioritize function before aesthetics, but without leaving the latter aside, since postoperative distortions can have a significant psychological impact. Objective To describe the authors’ experience in auricular reconstruction after Mohs surgery and to evaluate the most frequently used repair methods. Methods Retrospective study of consecutive cases submitted to Mohs surgery and auricular reconstruction, over a period of 3 years. Results One hundred and one cases were included and the most common repair method was primary closure (n = 35), followed by full-thickness skin graft (n = 30) and flaps (n = 24). In thirty cases, reconstruction methods were associated. Seven patients had complications (partial graft necrosis, postoperative bleeding or infection). Study limitations Retrospective design and the absence of long-term follow-up of some cases. Conclusions The dermatologic surgeon should be familiarized with different options for auricular reconstruction. Primary closure and skin grafts were the most frequently used repair methods.
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Affiliation(s)
- Guilherme Canho Bittner
- Dermatology Service, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil; Private Practice, Campo Grande, MS, Brazil.
| | | | - Bruno de Carvalho Fantini
- Dermatology Service, Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Felipe Bochnia Cerci
- Dermatology Service, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil; Postgraduate Program in Internal Medicine and Health Sciences, Universidade Federal do Paraná, Curitiba, PR, Brazil; Private Practice, Curitiba, PR, Brazil
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28
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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: 0] [Impact Index Per Article: 0] [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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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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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: 5] [Impact Index Per Article: 1.7] [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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Ilie G, Rutledge R, Sweeney E. An Examination of the Role of Socioeconomic Status in the Relationship between Depression and Prostate Cancer Survivorship in a Population-Based Sample of Men from Atlantic Canada. Oncology 2021; 99:260-270. [PMID: 33486485 DOI: 10.1159/000512444] [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: 09/01/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Prostate and skin cancer are among the most prevalent forms of cancer among men and have favorable survival rates compared to other, more aggressive forms of cancers. Recent studies have shown that the odds of depression among men with a lifetime history of prostate cancer are higher compared to men without a lifetime history of prostate cancer. Here we extend previous findings and examine the role of socioeconomic status in the relationship between depression and cancer survivorship status in a population-based sample of men from Atlantic Canada. METHODS A cross-sectional analysis was conducted on a subsample of 6,585 male participants aged 49-69 years from the 2009-2015 survey cycle of the Atlantic PATH study. The primary outcome was screening positive for mild, moderate or severe depression using the Patient Health Questionnaire (PHQ-9). The main predictor variable was cancer survivorship status (the presence of a lifetime history of prostate cancer, skin cancer, forms of cancer other than prostate or skin cancer, or absence of a lifetime cancer diagnosis). Covariates included age, education, marital status, household income, province, ethnicity, comorbidity, and survivorship time. RESULTS An estimated 14.7% of men in this sample screened positive for mild, moderate or severe depression. Men with a history of prostate cancer were 2.60 (95% CI: 1.02, 6.65) times more likely to screen positive for depression than men with a history of any other form of cancer. The odds ratios were 10.23 (95% CI: 2.82, 37.49) or 4.00 (95% CI: 1.20, 13.34) times higher for survivors of prostate or skin cancer who reported a low household income to screen positive for depression compared to men with a history of any other form of cancer and high household income. CONCLUSIONS These results extend current evidence of the association between prostate cancer survivorship and depression compared with men who never had a history of cancer diagnosis by indicating that this association still stands when the survivors of prostate cancer are compared to survivors of any other form of cancer, and further indicates that this association is moderated by household income. The findings highlight the importance of delivering mental health screening and support to prostate cancer survivors during the cancer journey, especially those with low household incomes.
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Affiliation(s)
- Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada, .,Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada, .,Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada,
| | - Robert Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ellen Sweeney
- Atlantic PATH, Dalhousie University, Halifax, Nova Scotia, Canada
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Pinatti de Moraes S, Marcolan J. Depressive symptoms in individuals with burns: A Brazilian study. INDIAN JOURNAL OF BURNS 2021. [DOI: 10.4103/ijb.ijb_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Omara S, Wen D, Ng B, Anand R, Matin RN, Taghipour K, Esdaile B. Identification of Incidental Skin Cancers Among Adults Referred to Dermatologists for Suspicious Skin Lesions. JAMA Netw Open 2020; 3:e2030107. [PMID: 33326027 PMCID: PMC7745102 DOI: 10.1001/jamanetworkopen.2020.30107] [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: 11/14/2022] Open
Abstract
IMPORTANCE The incidence of skin cancer is increasing and evaluation of the utility of total body skin examination (TBSE) in detecting incidental skin cancers is warranted. OBJECTIVES To evaluate the proportion and rate of incidental skin cancer detection in urgent skin cancer clinics and investigate the rate of incidental skin cancer detection in 2 groups based on the degree of clinical suspicion of the index lesion for malignancy. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study with a case note review of consecutive secondary care consultations was conducted using data from 2 urgent suspected skin cancer screening clinics in UK National Health Service trusts. The study was performed from January 1, 2015, to March 31, 2016, and data analysis was performed from October 14, 2018, to February 1, 2019. Patients included those presenting with a skin lesion suspicious of malignancy who were referred to the urgent suspected skin cancer clinic (N = 5944) over 15 months. Patients who accepted and received a TBSE were subsequently included in the analysis. MAIN OUTCOMES AND MEASURES The proportion and rate of incidental skin cancer detection through TBSE and whether a clinically suspicious (malignant) index lesion was associated with a higher chance of having a malignant incidental lesion. RESULTS Of the 5944 patients referred to the clinic, 4726 individuals (79.5%) were evaluated. In the cohort included in the analyses, the median age was 57 years (interquartile range, 39-73 years); 2567 patients (54.3%) were women. A total of 1117 skin cancers were identified; of these, 242 lesions (21.7%) were detected incidentally through TBSE, including 197 of 570 (34.6%) basal cell carcinomas, 16 of 250 (6.4%) squamous cell carcinomas, and 25 of 215 (11.6%) melanomas. The detection rate of incidental malignant lesions was 5.1 lesions per 100 patients examined (5.1%; 95% CI, 4.5%-5.8%). There was a higher detection rate of histologically confirmed incidental malignant lesions in individuals with clinically suspicious index lesions requiring biopsy (10.9%; 95% CI, 9.5%-12.5%) compared with those presenting with clinically benign index lesions (2.0%; 95% CI, 1.6%-2.5%) (P < .001). CONCLUSIONS AND RELEVANCE The findings of this study support the use of TBSE for urgent skin cancer referrals, highlighting the potential harms of solitary lesion assessment in a subgroup. Individuals presenting with a clinically suspicious index lesion requiring biopsy are most likely to benefit from TBSE and should be counseled regarding the benefit.
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Affiliation(s)
- Sharif Omara
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef, Leiden, the Netherlands
| | - David Wen
- Department of Dermatology, Oxford University Hospitals National Health Service Foundation Trust, Churchill Hospital, Headington, Oxford, United Kingdom
| | - Benjamin Ng
- Department of Dermatology, Oxford University Hospitals National Health Service Foundation Trust, Churchill Hospital, Headington, Oxford, United Kingdom
| | - Rakesh Anand
- Department of Dermatology, Whittington Health National Health Service Foundation Trust, London, United Kingdom
| | - Rubeta N. Matin
- Department of Dermatology, Oxford University Hospitals National Health Service Foundation Trust, Churchill Hospital, Headington, Oxford, United Kingdom
| | - Kathy Taghipour
- Department of Dermatology, Whittington Health National Health Service Foundation Trust, London, United Kingdom
| | - Ben Esdaile
- Department of Dermatology, Whittington Health National Health Service Foundation Trust, London, United Kingdom
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Dobbs TD, Ottenhof M, Gibson JAG, Whitaker IS, Hutchings HA. The Patient-Reported Outcome Measures In Skin Cancer Reconstruction (PROMISCR) study: Anglicisation and initial validation of the FACE-Q Skin Cancer Module in a UK cohort. J Plast Reconstr Aesthet Surg 2020; 74:615-624. [PMID: 33127351 DOI: 10.1016/j.bjps.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/09/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
Facial skin cancer is common, and its treatment affects patient's health-related quality of life (HRQoL), as demonstrated by patient-reported outcome measures (PROMs). In this study, we anglicise and validate the novel FACE-Q Skin Cancer Module for the UK population. Anglicisation of the FACE-Q Skin Cancer Module followed international guidance for cross-cultural adaptation. Cognitive interviews were performed, producing a reconciled and harmonised version for validation. Patients undergoing facial skin cancer excision were prospectively recruited and asked to complete the anglicised FACE-Q Skin Cancer Module, along with the Skin Cancer Index (SCI) and European Quality of Life-Five Dimensions (ED-5D) questionnaire, pre-operatively and 6-8 weeks post-operatively. Data were analysed using classical test theory. Ethical approval was obtained (REC: 16/WM/0445). One hundred and ten patients were recruited between August 2017 and July 2018. Internal consistency was high (Cronbach's alpha 0.867-0.967). All subscales had a single-factor solution using principal component analysis. Construct validity, as measured between the FACE-Q subscales and SCI subscales, was good, with >75% of a priori predictions confirmed. Pearson's r for item-total correlation was >0.80 for several items, and significant ceiling effects are shown in 7 of the 10 subscales, suggesting some item redundancy. The UK version of this well-designed PROM demonstrates good face and construct validity. There is however a degree of redundancy within the scales, and further work using Rasch analysis on a larger sample will help address this.
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Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK.
| | - Maarten Ottenhof
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands; Patient-Reported Outcomes, Value and Experience (PROVE) Centre, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - John A G Gibson
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - Hayley A Hutchings
- Health Services Research, Patient & Population Health & Informatics Research Group, Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
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Vollmann M, Engelhardt G, Salewski C. Effects of a brief multimodal online intervention on the intention to conduct sun protective behaviours through targeting illness representations about skin cancer: a randomized controlled trial. Psychol Health 2020; 36:253-270. [PMID: 32524850 DOI: 10.1080/08870446.2020.1775831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: The incidence of skin cancer can be reduced by increasing sun protective behaviours. Based on the Common-Sense Model and the Intervention Mapping approach, a brief intervention targeting illness representations about skin cancer to increase the intention to conduct sun protective behaviours was developed and evaluated regarding its effectiveness.Design: A randomized pre-post control group design with 509 healthy participants (69% women, mean age 39 years).Main outcome measures: Changes in illness representations about skin cancer (emotional representations, illness coherence, and prevention control) and the intention to conduct sun protective behaviours, i.e. UV protection and sun avoidance.Results: ANCOVAs showed that the intervention increased illness coherence and perceived prevention control as well as the intention to conduct sun protective behaviours. Mediation analyses revealed that the increase in illness coherence and/or perceived prevention control partially mediated the effect of the intervention on the increase of the intention to use UV protection (indirect effects: .02*, .06*) and to avoid sun exposure (indirect effects: .01 ns, .04*).Conclusion: The intervention was successful in changing illness representations and thereby increasing the intention to conduct sun protective behaviours. The findings provide evidence for the usefulness of the Common-Sense Model in the context of illness prevention.
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Affiliation(s)
- Manja Vollmann
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Gabriela Engelhardt
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Christel Salewski
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
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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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Sasor SE, Cook JA, Loewenstein SN, Wooden WA, Cohen AC, Chu MW, Tholpady SS. Patient-Reported Outcomes and Factors Associated With Patient Satisfaction After Surgical Treatment of Facial Nonmelanoma Skin Cancer. JAMA Surg 2019; 154:179-181. [PMID: 30422253 DOI: 10.1001/jamasurg.2018.3534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah E Sasor
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - Julia A Cook
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - Scott N Loewenstein
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
| | - William A Wooden
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis.,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Adam C Cohen
- Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Michael W Chu
- Department of Plastic and Reconstructive Surgery, Kaiser Permanente, Los Angeles, California
| | - Sunil S Tholpady
- Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis.,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
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Stundzaite-Barsauskiene G, Tutkuviene J, Barkus A, Jakimaviciene EM, Gibaviciene J, Jakutis N, Tutkus V, Venciute R, Dadoniene J. Facial perception, self-esteem and psychosocial well-being in patients after nasal surgery due to trauma, cancer and aesthetic needs (cluster analysis of multiple interrelations). Ann Hum Biol 2019; 46:537-552. [PMID: 31747819 DOI: 10.1080/03014460.2019.1690678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Facial anthropometric measurements in relation to self-esteem and self-perception have become a very popular topic, not only in anthropological and psychological research, but also in plastic reconstructive surgery.Aim: To compare the interrelations between facial perception, self-esteem and psychosocial well-being in patients after nasal surgery due to trauma, cancer and aesthetic needs.Subjects and methods: In total, ninety patients after nasal surgery (due to trauma, cancer and aesthetic reasons), and thirty control persons underwent facial anthropometry and answered questions related to facial perception (FP), self-esteem (SE) and psychosocial well-being (PW). Cluster analysis was performed.Results: Facial measurements were not related to the perception of the whole face in all investigated persons. The whole face and nasal perception were interrelated in the majority of male groups and in the control female group. SE in females from the control and cancer groups was not related to real facial parameters or FP, however, in females after aesthetic surgery it was related to nasal tip protrusion. SE in females after nasal surgery due to trauma was strongly related to FP. SE in almost all groups of males was related to real facial parameters, and in males after aesthetic surgery it was related to FP. PW was mostly linked to SE in males and females after aesthetic surgery, in other groups it was related to FP.Conclusions: FP was most frequently not related to real facial measurements; however, it was related to PW. Patients after aesthetic nasal surgery had specific relations between FP, SE and PW.
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Affiliation(s)
- Giedre Stundzaite-Barsauskiene
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Janina Tutkuviene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arunas Barkus
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Egle Marija Jakimaviciene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Nerijus Jakutis
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vytautas Tutkus
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ruta Venciute
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Dadoniene
- Centre of Plastic and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Restrepo S, Rojas S, Sanabria A. Cross-cultural adaptation and psychometric validation of the Patient Scar Assessment Questionnaire to the Spanish language in head and neck surgery. Int Wound J 2019; 17:21-31. [PMID: 31680458 DOI: 10.1111/iwj.13218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/18/2019] [Indexed: 11/27/2022] Open
Abstract
External appearance is the main aesthetic outcome in patients who undergo surgical procedures. Scars located in exposed areas, such as the neck and face, are important for patients. There are at least eight instruments that are used to evaluate postoperative scars, but few fulfil standard methodological conditions. The Patient Scar Assessment Questionnaire (PSAQ) was designed and validated using psychometric methodology. However, this scale has not been translated or validated in the Spanish language. The aim of this study was to undergo a cross-cultural adaptation and psychometric validation of the PSAQ scale to the Spanish language in patients who underwent head and neck surgery. We followed The Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for the translation and validation of health-related scales. Forward and back translations were made by independent translators. We included adult patients who underwent thyroidectomy, parathyroidectomy, parotidectomy, and neck dissection. For the psychometric validation, we used a principal axis exploratory factor analysis with oblimin rotation. A reliability test involving Cronbachs alpha and the item-total correlation was performed and for the convergent/concurrent validity, we selected the Spanish version of the Vancouver Scar Scale. A total of 180 patients were recruited. Factor analysis showed a five-factor solution. Cronbachs alpha for the subscales was >0.7. The comparison between the PSAQ appearance subscale and the VSS demonstrated a high correlation (rho = - 0.89). In a sample of 62 patients, the test-retest evaluation showed high correlation (0.74-0.99). Our study supports the Spanish version of the PSAQ as a valid, reliable, and reproducible tool to assess the perception and impact of neck scars in Spanish-speaking patients who undergo head and neck surgery.
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Affiliation(s)
- Santiago Restrepo
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Santiago Rojas
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia.,Head and Neck Service, Fundación Colombiana de Cancerología-Clínica Vida, Medellín, Colombia.,Centro de Excelencia en Cirugía de Cabeza y Cuello, CEXCA, Medellín, Colombia
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40
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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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41
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Zhang J, Miller CJ, O'Malley V, Bowman EB, Etzkorn JR, Shin TM, Sobanko JF. Patient and Physician Assessment of Surgical Scars: A Systematic Review. JAMA FACIAL PLAST SU 2019; 20:314-323. [PMID: 29392275 DOI: 10.1001/jamafacial.2017.2314] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Surgical scarring affects patients by distracting the gaze of onlookers, disrupting social interactions, and impairing psychosocial health. Patient and physician agreement regarding ideal scar characteristics is important in developing congruent expectations after surgery. Objective To summarize published studies assessing patient and physician ratings of surgical scars, rates of patient and physician agreement in scar assessment, and elements of cutaneous scar assessment that differ between patients and physicians. Evidence Review A literature search of Ovid/Medline, PubMed, and EMBASE was conducted from January 1, 1972, to August 1, 2015. Prospective studies comparing scars from different surgical techniques using at least 1 physician-reported and patient-reported scar measure were included. Strength of studies was graded according to the Oxford Centre for Evidence-Based Medicine guidelines. Findings The review identified 29 studies comprising 4485 patients. Of the 29 included studies, 20 (69%) were randomized clinical trials (RCTs), 5 (17%) were prospective, nonrandomized studies, and 4 (14%) were descriptive studies. Disagreement between patients and physician evaluation of scars occurred in 28% (8 of 29) studies, with only patients rating scar difference in 75% (6 of 8) of these cases. Patients were more likely to value scar depth while physicians were more likely to value scar pigmentation and relief. Conclusions and Relevance Methodologically rigorous studies that include clinician- and patient-reported scar outcomes are uncommon. Studies that incorporate subjective and objective scar grading reveal disagreement between patients and clinicians. Of the incision and wound closure techniques assessed, few affected patient- and clinician-reported outcomes, but the evidence remains weak and future studies are recommended.
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Affiliation(s)
- Junqian Zhang
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | | | - Eric B Bowman
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia
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Liu CJ, Fang KH, Chang CC, Lin ET, Chang GH, Shen JH, Chen YT, Tsai YT. Application of "parachute" technique for free flap reconstruction in advanced tongue cancer after ablation without lip-jaw splitting: A retrospective case study. Medicine (Baltimore) 2019; 98:e16728. [PMID: 31415367 PMCID: PMC6831483 DOI: 10.1097/md.0000000000016728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The hemi or subtotal/total glossectomy is usually approached by lip-jaw splitting procedure for advanced tongue cancer ablation. This highly invasive procedure can cause facial disfiguration, bone malunion, and osteoradionecrosis. The aim of this study is to compare the surgical outcome in free flap tongue reconstruction between novel parachute technique in an intact jaw and the conventional lip-jaw splitting procedure after tongue cancer ablation.In this study, parachute technique was adopted for free flap inset in patients without mandibulotomy. We retrospectively reviewed patients who have received primary advanced tongue cancer resection and free flap reconstruction during April, 2008 to January, 2015. Patients were divided into 2 groups. Group A was undergoing parachute technique without lip-jaw splitting. We sutured all the strings through the edges of defect in the first step and through the matching points of flap margin in the second step from outside the oral cavity. Then, the strings were pulled and the flap was parachuted down on the defects after all the matching points were tied together. In group B, the patients received conventional lip-jaw splitting procedure. Student t test was used for results analysis.There were 15 patients (n = 15) in group A and 15 patients (n = 15) in group B. In the patients receiving parachute technique, operation time showed 34 minutes (P = .49) shorter, hospital stay showed 4 days (P = .32) shorter, and the infection rate of surgical site showed 6.6% (P = .64) less than with conventional technique. The survival rates of the flaps were both 100% without revision.The parachute technique is an effective and more accessible method for free flap setting in cases of tongue reconstruction without lip-jaw splitting, and provides patients with better aesthetic appearance.
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Affiliation(s)
- Chin-Jui Liu
- Department of Otolaryngology, An-Nan Hospital, China Medical University, Tainan
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Ku-Hao Fang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Chang-Cheng Chang
- School of Medicine, College of Medicine, China Medical University
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung
| | - Erh-Ti Lin
- School of Medicine, College of Medicine, China Medical University
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
| | - Jen-Hsiang Shen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan
| | - Yu-Tsung Chen
- Department of Dermatology, Shuang Ho Hospital, Taipei, Taiwan (R.O.C.)
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi
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43
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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: 18] [Impact Index Per Article: 3.6] [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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Rossi AM, Sobanko J, Lawrence N, Bordeaux J, Cartee T, Armbrecht ES, Behera A, Baum CL, Alam M, Maher IA. Physician-Centered Outcomes for Skin Cancer Treatment: A Single-Day Modified Delphi Process to Assess the Importance of Themes in Skin Cancer Management. Dermatol Surg 2019; 45:869-874. [PMID: 30807387 PMCID: PMC6860020 DOI: 10.1097/dss.0000000000001835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Success in skin cancer treatment is determined through outcome measurement. Patients and physicians may prioritize different outcomes of care, and identification of such may enhance patient-centered care. OBJECTIVE To identify gaps between patient and physician attitudes toward skin cancer outcomes. MATERIALS AND METHODS A single-day, 21-patient, modified, in-person Delphi process to solicit and rate the importance of skin cancer-related outcomes was conducted. Twelve masked dermatologic surgeons rated patient-generated outcomes in a 2-round modified Delphi process. Each item was rated on a 1 to 9 scale (1, least important; 9, most important) using the Qualtrics web platform (Qualtrics, Provo, UT). Results of the physician ratings were compared with the patient ratings. RESULTS A list of 53 skin cancer treatment-related themes and outcomes was generated. Eight items were ranked by physicians as "very high" (>80% importance), 5 as "high" (>70% importance), 19 as intermediate, and 21 as low. The physician and patient panels' ratings were concordant for 56% of items, whereas 7 outcome items showed a 2-category discordance. CONCLUSION Physicians and patients were concordant regarding skin cancer treatment on multiple spheres. Areas of discordance include patient fear of unknown future risk, recurrence, or empowering patients to make treatment choices, and may be areas of continued improvement for delivery of patient-centered care.
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Affiliation(s)
- Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Joseph Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naomi Lawrence
- Center for Dermatologic Surgery, Cooper University Hospital, Camden, New Jersey
- Department of Dermatology, Rowan University, Camden, New Jersey
| | - Jeremy Bordeaux
- Department of Dermatology, Case Western Reserve University and University Hospitals, Cleveland, Ohio
| | | | - Eric S Armbrecht
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri
| | - Anit Behera
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri
| | | | - Murad Alam
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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45
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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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46
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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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47
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Dobbs TD, Samarendra H, Hughes S, Hutchings HA, Whitaker I. Patient-reported outcome measures for facial skin cancer: a systematic review and evaluation of the quality of their measurement properties. Br J Dermatol 2018; 180:1018-1029. [PMID: 30362522 DOI: 10.1111/bjd.17342] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Skin cancer is the commonest malignancy worldwide, often occurring on the face. Both the condition and treatment can lead to scarring and facial disfigurement, affecting a patient's health-related quality of life (HRQoL), which can be measured using patient-reported outcome measures (PROMs). OBJECTIVES This systematic review identifies PROMs for facial skin cancer and appraises their methodological quality and psychometric properties using up-to-date methods. METHODS MEDLINE, Embase, PsycINFO, Cochrane and CINAHL were searched systematically in accordance with PRISMA guidelines, identifying all PROMs designed for or validated in facial skin cancer. Methodological quality and evidence of psychometric properties were assessed using the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) checklist and criteria proposed by Terwee and colleagues. A best-evidence synthesis and assessment of instrument focus on post-resection reconstruction was also performed. RESULTS We included 24 studies on 11 PROMs. Methodological quality and psychometric evidence was variable, with the Patient Outcome of Surgery - Head/Neck (POS-H/N), Skin Cancer Index (SCI), Skin Cancer Quality of Life Impact Tool (SCQOLIT) and Essers and colleagues demonstrating the greatest level of validation. None scored well in their relevance to post-skin cancer reconstruction of the face. CONCLUSIONS This systematic review critically appraises PROMs for facial skin cancer using internationally accepted criteria. The identified PROMs demonstrate a variation in the quality of validation performed, with a need to improve this across all PROMs in the field. Only through improving the quality of available PROMs and their focus on the post-treatment aesthetic and functional outcome will we be able to truly appreciate the concerns of our patients and improve the management of facial skin cancer.
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Affiliation(s)
- T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
| | | | - S Hughes
- Patient and Population Health and Informatics, Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend, U.K
| | - H A Hutchings
- Patient and Population Health and Informatics, Institute of Life Science 2, Swansea University Medical School, Swansea, U.K
| | - I Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
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48
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Heaton H, Lawrence N. Nonmelanoma skin cancer in women. Int J Womens Dermatol 2018; 5:2-7. [PMID: 30809571 PMCID: PMC6374707 DOI: 10.1016/j.ijwd.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 02/07/2023] Open
Abstract
Men continue to develop nonmelanoma skin cancer (NMSC) at higher rates than women, but the epidemiologic pattern of NMSC development is evolving. We present a selective, narrative review of the literature showing that there is a trend toward a development of basal cell carcinomas in women at younger ages, and highlight potential causes of this trend. We review evidence that indoor tanning is associated with the development of NMSC and show that young women use indoor tanning more than any other age-sex group. We discuss societal factors that relate to the tanning behavior of young women. Finally, we argue that facial NMSCs may have more of a negative impact on quality of life in women than in men.
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Affiliation(s)
- H. Heaton
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, Connecticut
- Corresponding author.
| | - N. Lawrence
- Division of Dermatology, Cooper University Hospital Medical Center, Marlton, New Jersey
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49
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The rule of 10s versus the rule of 2s: High complication rates after conventional excision with postoperative margin assessment of specialty site versus trunk and proximal extremity melanomas. J Am Acad Dermatol 2018; 85:442-452. [PMID: 30447316 DOI: 10.1016/j.jaad.2018.11.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/25/2018] [Accepted: 11/03/2018] [Indexed: 01/01/2023]
Abstract
Specialty site melanomas on the head and neck, hands and feet, genitalia, and pretibial leg have higher rates of surgical complications after conventional excision with postoperative margin assessment (CE-POMA) compared with trunk and proximal extremity melanomas. The rule of 10s describes complication rates after CE-POMA of specialty site melanomas: ∼10% risk for upstaging, ∼10% risk for positive excision margins, ∼10% risk for local recurrence, and ∼10-fold increased likelihood of reconstruction with a flap or graft. Trunk and proximal extremity melanomas encounter these complications at a lower rate, according to the rule of 2s. Mohs micrographic surgery (MMS) with frozen section melanocytic immunostains (MMS-I) and slow Mohs with paraffin sections decrease complications of surgery of specialty site melanomas by detecting upstaging and confirming complete tumor removal with comprehensive microscopic margin assessment before reconstruction. This article reviews information important for counseling melanoma patients about surgical treatment options and for developing consensus guidelines with clear indications for MMS-I or slow Mohs.
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50
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Weitemeyer MB, Bramsen P, Klausen TW, Hölmich LR, Gjorup CA. Patient-and observer-reported long-term scar quality of wide local excision scars in melanoma patients. J Plast Surg Hand Surg 2018; 52:319-324. [PMID: 30380964 DOI: 10.1080/2000656x.2018.1493388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Wide local excision of the primary tumour is the mainstay of treatment for melanoma patients. The aims of this study were to assess the patient- and observer-reported long-term scar quality after surgery using the patient and observer scar assessment scale (POSAS) in melanoma patients, to assess the reliability and validity of POSAS, and to identify factors influencing the scar assessment. This cross-sectional clinical study included 320 melanoma patients with primary tumours on the trunk and limbs. Data regarding patients, treatment, scar characteristics and functional outcomes was analysed. Internal consistency, inter-rater reliability, and convergent validity were examined. Factors influencing the patient- and observer-reported scar quality were tested using regression analyses. Results of the POSAS showed an overall good scar quality. The internal consistency of POSAS was good, and the convergent validity was strong. The inter-rater reliability was only moderate. The patients were influenced by the POSAS sub-items: colour, irregularity, thickness and pain. The observer was influenced by the POSAS sub-items: vascularity, surface area, thickness, relief and pliability. Both patient- and observer-reported scar qualities were influenced by age, location, type of superficial suture, keloids and widened scars. Moreover, the patients were influenced by the scar tightness while the observer was influenced by postoperative complications, hypertrophic scars, suture marks and dog ears. In conclusion POSAS is a reliable and valid scar assessment tool. The factors influencing patient- and observer-reported scar quality differed, and better understanding of this may improve treatment and hence patient-reported scar quality.
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Affiliation(s)
- Marie B Weitemeyer
- a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
| | - Pernille Bramsen
- a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
| | - Tobias W Klausen
- b Department of Haematology , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
| | - Lisbet R Hölmich
- a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
| | - Caroline A Gjorup
- a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
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