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.
Bibliographical noteFunding Information:
receiving a grant from Penn Center for Human Appearance 2018, awarded for Assessment of Quality of Life & Nasal Function Following Mohs Surgery, during the conduct of the study. Dr Albertini reported serving on the Board of Managers, being a minority shareholder of, and being Chief Medical Officer for QualDerm Partners outside the submitted work. Dr Bar reported receiving consulting fees from Castle and Regeneron outside the submitted work. Dr Shin reported receiving grants from Regeneron outside the submitted work. Dr Wysong reported receiving grants from Castle Biosciences outside the submitted work. Dr Etzkorn reported receiving a Dermatology Foundation Career Development Award in Dermatologic Surgery. No other disclosures were reported.
© 2021 American Medical Association. All rights reserved.
PubMed: MeSH publication types
- Journal Article
- Multicenter Study