TY - JOUR
T1 - Patient Quality of Life after Interpolated Flap Repair of Nasal Mohs Surgery Defects
T2 - A Multicenter Prospective Cohort Study
AU - Lukowiak, Tess M.
AU - Perz, Allison M.
AU - Veerabagu, Surya A.
AU - Lee, Michael P.
AU - Neal, Donald
AU - Aizman, Leora
AU - Miller, Christopher J.
AU - Golda, Nicholas
AU - Albertini, John G.
AU - Holmes, Todd
AU - Bar, Anna
AU - Leitenberger, Justin
AU - Maher, Ian A.
AU - Sobanko, Joseph F.
AU - Chen, David
AU - Aasi, Sumaira
AU - Sutton, Adam
AU - Higgins, H. William
AU - Shin, Thuzar M.
AU - Weinberger, Christine
AU - Mattox, Adam
AU - Wysong, Ashley
AU - Etzkorn, Jeremy R.
N1 - Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - 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.
AB - 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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U2 - 10.1001/jamadermatol.2021.3161
DO - 10.1001/jamadermatol.2021.3161
M3 - Article
C2 - 34431977
AN - SCOPUS:85114104241
SN - 2168-6068
VL - 157
SP - 1213
EP - 1216
JO - JAMA Dermatology
JF - JAMA Dermatology
IS - 10
ER -
