Comparison of Accuracy of Patient and Physician Scar Length Estimates Before Mohs Micrographic Surgery for Facial Skin Cancers

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.

Mekeres’ Psychosocial Internalization Scale: A Scale for the Evaluation of Aesthetic Prejudice in Victims of Accidents and Violence

“…Several studies mention that through "significant others," they want to capture the way they perceive people who are useful to them and to whom they relate in various life contexts such as doctors, psychologists, priests, etc. [15,24,25,27,28].…”

“…Given that the items of the VSS scale are virtually uncorrelated, the separate associations of MPIS show that this instrument is not a simple measurement of only negative emotions. We consider that the results presented in the validation study bring evidence regarding the psychometric solidity of the MPIS scale [17,27,28]. We developed this scale for the evaluation of victims of accidents and violence but similarly to the Vancouver scale, which was first developed to assess burn scars, MPIS could be adapted to assess the psycho-social impact of other types of scars, such as those following surgery or oncologic procedures.…”

The Natural Evolution of Facial Surgical Scars: A Retrospective Study of Physician-Assessed Scars Using the Patient and Observer Scar Assessment Scale Over Two Time Points

“…10 One strategy to set realistic expectations is to address common patient misconceptions. For example, since 80% of Mohs micrographic surgery (MMS) patients expect scars to be less than half of their actual final length, 11 surgeons can realign expectations by emphasizing the anticipated length of scar before surgery. Another strategy to set expectations is to explain how the appearance of the scar will change after surgery.…”

Agreement between patients and surgeons on assessments of the cosmetic outcomes of Mohs micrographic surgery: Results of a single-center blinded prospective study

“…To the Editor: Patient satisfaction with wound reconstruction following Mohs micrographic surgery (MMS) is crucial. 1 , 2 , 3 , 4 , 5 Whether patients and their surgeons assess wound cosmetic outcomes similarly is still unknown. We aimed to examine whether patients and their Mohs surgeons agree with respect to their assessments of the cosmetic outcomes of MMS.…”

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Agreement between patients and surgeons on assessments of the cosmetic outcomes of Mohs micrographic surgery: Results of a single-center blinded prospective study To the Editor: Patient satisfaction with wound reconstruction following Mohs micrographic surgery (MMS) is crucial. [1][2][3][4][5] Whether patients and their surgeons assess wound cosmetic outcomes similarly is still unknown. We aimed to examine whether patients and their Mohs surgeons agree with respect to their assessments of the cosmetic outcomes of MMS.Following ethical approval, all patients who underwent MMS at Sk ane University Hospital between 2010 and 2018 were assessed 6 months after MMS.

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