Patient Quality of Life After Interpolated Flap Repair of Nasal Mohs Surgery Defects

Abstract

IMPORTANCESingle-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 PARTICIPANTSThis 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 MEASURESMean 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.

Quantification of Erythema Associated With Varying Suture Materials in Facial Surgery Repair: A Randomized Prospective Study

“…2 The information on scar erythema drawn from our study can help counsel patients, manage their expectations, and therefore improve QOL perioperatively. 2,13 In the future, there may be clinical utility and feasibility of computer-assisted image processing to quantify and track skin erythema over time in other dermatologic conditions, such as rosacea. 18 In addition, this technology may be used alongside tele-dermatology to quantitatively assess photos submitted by patients.…”

“…1,13 Scar cosmesis contributes to QOL and has implications on mental health and function. 2 The information on scar erythema drawn from our study can help counsel patients, manage their expectations, and therefore improve QOL perioperatively. 2,13 In the future, there may be clinical utility and feasibility of computer-assisted image processing to quantify and track skin erythema over time in other dermatologic conditions, such as rosacea.…”

“…Surgical excision is the preferred management for most nonmelanoma skin cancers (NMSC) of the face. 1,2 Given the aesthetic importance of the face, patients are often concerned about scar cosmesis postoperatively, including residual erythema, with many patients seeking treatment to reduce scar redness. 2–4…”

“…1,2 Given the aesthetic importance of the face, patients are often concerned about scar cosmesis postoperatively, including residual erythema, with many patients seeking treatment to reduce scar redness. [2][3][4] Erythema has classically been believed to be greater with braided absorbable sutures (irradiated polyglactin-910 [IPG]), or sutures undergoing proteolysis (fast-absorbing gut [FG]), compared with perceived inert materials such as nylon. As a result, IPG or FG sutures have historically been less commonly used for epidermal closure of the face.…”

State of the Evidence for Facial Skin Cancer Reconstruction

“…Retrospective evidence finds that the drop in quality of life improves significantly at 16 weeks postflap takedown with no lasting, long-term impact (p < 0.001). 72 Many reconstructive surgeons advocate for the use of Doppler signaling despite the reliable anatomical location of the supratrochlear artery. 73 However, Stigall et al have demonstrated no difference in complication rates or long-term outcomes when Doppler signaling was or was not used.…”