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Ottenhof MJ, Dobbs TD, Veldhuizen I, Harrison CJ, Marges M, Lee EH, Hoogbergen MM, van der Hulst RR, Pusic AL, Sidey-Gibbons CJ. FACE-Q for Measuring Patient-reported Outcomes after Facial Skin Cancer Surgery: Cross-cultural Validation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5771. [PMID: 38689944 PMCID: PMC11057807 DOI: 10.1097/gox.0000000000005771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/27/2023] [Indexed: 05/02/2024]
Abstract
Background Facial skin cancer and its surgical treatment can affect health-related quality of life. The FACE-Q Skin Cancer Module is a patient-reported outcome measure that measures different aspects of health-related quality of life and has recently been translated into Dutch. This study aimed to evaluate the performance of the translated version in a Dutch cohort using modern psychometric measurement theory (Rasch). Methods Dutch participants with facial skin cancer were prospectively recruited and asked to complete the translated FACE-Q Skin Cancer Module. The following assumptions of the Rasch model were tested: unidimensionality, local independence, and monotonicity. Response thresholds, fit statistics, internal consistency, floor and ceiling effects, and targeting were assessed for all scales and items within the scales. Responsiveness was tested for the "cancer worry" scale. Results In total, 259 patients completed the preoperative questionnaire and were included in the analysis. All five scales assessed showed a good or sufficient fit to the Rasch model. Unidimensionality and monotonicity were present for all scales. Some items showed a local dependency. Most of the scales demonstrate ordered item thresholds and appropriate fit statistics. Conclusions The FACE-Q Skin Cancer Module is a well-designed patient-reported outcome measure that shows psychometric validity for the translated version in a Dutch cohort, using classical and modern test theory.
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Affiliation(s)
- Maarten J. Ottenhof
- From Patient-Reported Outcomes, Value & Experience (PROVE) Center, Department of Surgery, Brigham and Women’s Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Thomas D. Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, United Kingdom
| | - Inge Veldhuizen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Conrad J. Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Michelle Marges
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - Erica H. Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Maarten M. Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - René R.W.J. van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrea L. Pusic
- From Patient-Reported Outcomes, Value & Experience (PROVE) Center, Department of Surgery, Brigham and Women’s Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
| | - Chris J. Sidey-Gibbons
- From Patient-Reported Outcomes, Value & Experience (PROVE) Center, Department of Surgery, Brigham and Women’s Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
- MD Anderson Center for INSPiRED Cancer Care, University of Texas MD Anderson Cancer Center, Houston, Tex
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Dodson JA, Ibrahim SA, Rogers H, Council ML, Nehal KS, Tung R, Leffell DJ, Zeitouni NC, Totonchy MB, Fosko SW, Lee Soon S, Blalock TW, Brodland DG, Billingsley EM, Scott JF, Leach BC, Ratner D, Washington C, Hanke CW, Otley CC, Golda N, Nijhawan RI, Brewer J, Demer A, Fish F, Harmon CB, Zitelli J, Knackstedt T, Singh G, Mollet T, Carr DR, Albertini JG, Moody BR, McDonald M, Bordeaux JS, Massey PR, MacCormack MA, Vidimos A, Arpey CJ, Arron ST, Ibrahimi OA, Jiang SB, Miller CJ, Maher IA, Wysong A, Leshin B, Goldman GD, Kibbi N, Feng H, Collins L. Identifying critical quality metrics in Mohs Surgery: A national expert consensus process. J Am Acad Dermatol 2024; 90:798-805. [PMID: 38081390 DOI: 10.1016/j.jaad.2023.10.069] [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: 11/25/2022] [Revised: 08/16/2023] [Accepted: 10/20/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Amid a movement toward value-based healthcare, increasing emphasis has been placed on outcomes and cost of medical services. To define and demonstrate the quality of services provided by Mohs surgeons, it is important to identify and understand the key aspects of Mohs micrographic surgery (MMS) that contribute to excellence in patient care. OBJECTIVE The purpose of this study is to develop and identify a comprehensive list of metrics in an initial effort to define excellence in MMS. METHODS Mohs surgeons participated in a modified Delphi process to reach a consensus on a list of metrics. Patients were administered surveys to gather patient perspectives. RESULTS Twenty-four of the original 66 metrics met final inclusion criteria. Broad support for the initiative was obtained through physician feedback. LIMITATIONS Limitations of this study include attrition bias across survey rounds and participation at the consensus meeting. Furthermore, the list of metrics is based on expert consensus instead of quality evidence-based outcomes. CONCLUSION With the goal of identifying metrics that demonstrate excellence in performance of MMS, this initial effort has shown that Mohs surgeons and patients have unique perspectives and can be engaged in a data-driven approach to help define excellence in the field of MMS.
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Affiliation(s)
- Joseph A Dodson
- Rush Medical College of Rush University Medical Center, Chicago, Illinois
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Howard Rogers
- President, American College of Mohs Surgery, CMO, Advanced Dermatology, Norwich, Connecticut
| | - M Laurin Council
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca Tung
- Florida Dermatology and Skin Cancer Centers, Winter Haven, Florida
| | - David J Leffell
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Nathalie C Zeitouni
- Division of Dermatology, Department of Internal Medicine, University of Arizona, Phoenix, Arizona
| | | | - Scott W Fosko
- Department of Dermatology, University of Florida, Gainesville, Florida
| | | | - Travis W Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian C Leach
- The Skin Surgery Center of Charleston, Mount Pleasant, South Carolina
| | - Desiree Ratner
- Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Carl Washington
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Partner; Dermatology Associates of Georgia, Decatur, Georgia
| | - C William Hanke
- Laser and Skin Surgery Center of Indiana, Indianapolis, Indiana; Program Director, ACGME Micrographic Surgery/Dermatologic Oncology Fellowship Training Program, Ascension St. Vincent Hospital, Indianapolis, Indiana; Department of Dermatology, University of Iowa-Carver College of Medicine, Iowa City, Iowa
| | - Clark C Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas Golda
- Dermatology and Skin Cancer Centers, Kansas City, Missouri
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jerry Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Frederick Fish
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - John Zitelli
- Department of Dermatology, Otolaryngology, and Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas Knackstedt
- Mohs Surgery Unit, Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina; Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Todd Mollet
- Department of Dermatology, Skin Surgery Center of Oklahoma, Oklahoma City, Oklahoma
| | - David R Carr
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Michel McDonald
- Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, Warren Alpert Medical School at Brown University, Worcester, Massachusetts
| | | | | | - Allison Vidimos
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Omar A Ibrahimi
- Department of Dermatology, Connecticut Skin Institute, Stamford, Connecticut
| | | | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Barry Leshin
- Department of Dermatology, Skin Surgery Center, Winston-Salem, North Carolina
| | | | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Lindsey Collins
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Theelen FFM, Veldhuizen IJ, Zhou C, Lee EH, van Hensbergen LJ, Broekhuysen CL, van der Hulst RRWJ, Hoogbergen MM. Patient Satisfaction Following Primary Closure or Second Intention Healing After Conventional Nasal Skin Cancer Excision: A Cross-sectional Cohort Study. Dermatol Surg 2024; 50:247-255. [PMID: 38048208 DOI: 10.1097/dss.0000000000004037] [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: 12/06/2023]
Abstract
BACKGROUND Nasal reconstruction after conventional surgical excision (CSE) of nonmelanoma skin cancer (NMSC) can be challenging. After excision and before the pathologic report, a simple reconstruction is favored. Yet, little is known about patient satisfaction after primary closure and second intention healing. OBJECTIVE Patient satisfaction after nasal defect reconstruction with primary closure or second intention healing, using the FACE-Q Skin Cancer. METHODS All patients who underwent CSE of nasal NMSC with immediate primary closure or second intention healing between March 2018 and March 2020 at Máxima Medisch Centrum Veldhoven were identified and asked to complete the FACE-Q Skin Cancer. RESULTS Of 183 patients, 140 patients completed the questionnaire. Fifty-five defects were closed by primary closure (38.5%) and 88 by second intention healing (61.5%). Thirty-one complications were reported (16.7%), of which 87.1% ( n = 27) after second intention healing ( p = .004). Both groups experienced high facial and scar satisfaction, low appearance-related distress, and no to minimal adverse effects. Second intention healing had 2.7 higher odds of achieving the maximum scar satisfaction score ( p = .02). CONCLUSION This study shows high satisfaction on facial and scar appraisal, low appearance-related distress, and no to minimal adverse effects for second intention healing and primary closure after CSE of nasal NMSC.
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Affiliation(s)
- Frederieke F M Theelen
- Department of Plastic and Reconstructive Surgery, Máxima Medisch Centrum, Veldhoven, the Netherlands
- 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
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Chao Zhou
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Erica H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York
| | - Lusanne J van Hensbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Coralien L Broekhuysen
- Department of Plastic and Reconstructive Surgery, Máxima Medisch Centrum, Veldhoven, 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
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Yung AE, Luong J, Crouch G, Hong AM, Ananda A, Taylor S, Kotronakis I, Low TH(H, Elliott MS, McBride K, Rutherford C, Clark JR, Ch’ng S. First Phase Development of a Patient-reported Outcome Measure for Midface Oncology. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5689. [PMID: 38525491 PMCID: PMC10959565 DOI: 10.1097/gox.0000000000005689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/06/2024] [Indexed: 03/26/2024]
Abstract
Background Facial cancer surgery involving the midface (comprising the lower eyelids, nose, cheeks, and upper lip) can have debilitating life-changing functional, social, and psychological impacts on the patient. Midface symptoms are inadequately captured by existing patient-reported outcome measures (PROMs). PROMs are increasingly used for individual patient care, quality improvement, and standardized reporting of treatment outcomes. This study aimed to present our findings from the first phase of the development of a midface, specifically periocular and nasal, PROM. Methods After international guidance for PROM development, the first phase comprised identification of salient issues and item generation. Fifteen patients who had midface surgery and 10 clinicians from various specialties with more than 5 years' experience treating these patients were recruited. Semi-structured interviews explored aesthetic, functional, social, and psychological outcomes, with specific attention to deficiencies in current PROMs. Thematic analysis was used to develop an item pool, and group interviews with clinicians were carried out to create and refine PROM scales. Results Qualitative data from patient interviews were grouped into aesthetic, functional, and psychosocial domains for the eyelids and nose. Ninety-nine draft items were generated across these domains. Following focus group discussions, the final version of the midface-specific PROM contained 31 items (13 eye-specific, 10-nose-specific, eight general midface items). Conclusions This midface-specific PROM is valuable in assessing and comparing patient-reported outcomes in those who have undergone complex resection and reconstruction of the midface. This PROM is currently undergoing field testing.
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Affiliation(s)
- Amanda E. Yung
- From the Sydney Medical School, University of Sydney, NSW, Australia
- Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jason Luong
- From the Sydney Medical School, University of Sydney, NSW, Australia
- Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Gareth Crouch
- From the Sydney Medical School, University of Sydney, NSW, Australia
- Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Angela M. Hong
- From the Sydney Medical School, University of Sydney, NSW, Australia
- Department of Radiation Oncology, Chris O’Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
- Melanoma Institute Australia, University of Sydney, NSW, Australia
| | - Arjuna Ananda
- Department of Ear, Nose and Throat Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Simon Taylor
- Department of Oculoplastic Surgery, Sydney Adventist Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ilias Kotronakis
- Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Tsu-Hui (Hubert) Low
- From the Sydney Medical School, University of Sydney, NSW, Australia
- Department of Ear, Nose and Throat Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Head & Neck Cancer Institute, Chris O’Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
| | - Michael S. Elliott
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Kate McBride
- Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Claudia Rutherford
- Faculty of Medicine and Health, Sydney Nursing School, Cancer Care Research Unit (CNRU), Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Jonathan R. Clark
- Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Head & Neck Cancer Institute, Chris O’Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
| | - Sydney Ch’ng
- Institute of Academic Surgery at Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Melanoma Institute Australia, University of Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Head & Neck Cancer Institute, Chris O’Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
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5
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Nierich J, Corten E, de Jong T, Mureau M. Long-Term Patient-Reported Outcomes following Oncological Facial Reconstructive Surgery using the FACE-Q Skin Cancer Module. JPRAS Open 2024; 39:262-270. [PMID: 38351901 PMCID: PMC10861937 DOI: 10.1016/j.jpra.2024.01.003] [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: 10/03/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
Background Long-term patient-reported outcomes (PROs) of oncological facial reconstructive surgery are unknown. Objective The present study aimed to assess long-term PROs and to identify possible correlations between patient and treatment characteristics and long-term PROs. Methods & Materials Between 2006 and 2011, 202 patients underwent facial reconstruction after Mohs micrographic surgery for non-melanoma skin cancer at our institution. After 10 years of follow-up, 96 out of the remaining 122 patients completed the FACE-Q Skin Cancer Module. Results Patients who were surgically treated for squamous cell carcinoma reported poorer scores on the satisfaction with facial appearance (p=0.038), appraisal of scars (p=0.039) and appearance-related psychosocial distress scales (p=0.036) compared to patients with basal cell carcinoma and lentigo maligna. Finally, female patients reported significantly higher scores on the Cancer Worry Scale than male patients (p=0.047). Conclusion Long-term patient satisfaction with respect to their facial appearance and scars after reconstructive surgery for skin cancer was comparable to short-term patient satisfaction, whereas Cancer Worry Scale and psychosocial distress appeared to be slightly higher. Our results can be used to better inform patients on the long-term effects of facial reconstructive surgery on patient satisfaction and quality of life, which are important to improve patient counselling, patient expectation management and shared decision-making.
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Affiliation(s)
- J. Nierich
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E.M.L. Corten
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - T. de Jong
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M.A.M. Mureau
- Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Lawrence A, Beatty S, French E, Somani S, Sykes K, Kriet D, Humphrey C. Identifying Gaps in Patient Preparation for Staged Reconstruction After Skin Cancer Resection After Mohs Micrographic Surgery. Facial Plast Surg Aesthet Med 2024; 26:73-75. [PMID: 37339437 DOI: 10.1089/fpsam.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Anna Lawrence
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Simon Beatty
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Emilie French
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Shaan Somani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kevin Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - David Kriet
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Clint Humphrey
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
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7
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Kim S, Day CM, Song Y, Holmes A, Garg S. Innovative Topical Patches for Non-Melanoma Skin Cancer: Current Challenges and Key Formulation Considerations. Pharmaceutics 2023; 15:2577. [PMID: 38004557 PMCID: PMC10674480 DOI: 10.3390/pharmaceutics15112577] [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: 10/18/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Non-melanoma skin cancer (NMSC) is the most prevalent malignancy worldwide, with approximately 6.3 million new cases worldwide in 2019. One of the key management strategies for NMSC is a topical treatment usually utilised for localised and early-stage disease owing to its non-invasive nature. However, the efficacy of topical agents is often hindered by poor drug penetration and patient adherence. Therefore, various research groups have employed advanced drug delivery systems, including topical patches to overcome the problem of conventional topical treatments. This review begins with an overview of NMSC as well as the current landscape of topical treatments for NMSC, specifically focusing on the emerging technology of topical patches. A detailed discussion of their potential to overcome the limitations of existing therapies will then follow. Most importantly, to the best of our knowledge, this work unprecedentedly combines and discusses all the current advancements in innovative topical patches for the treatment of NMSC. In addition to this, the authors present our insights into the key considerations and emerging trends in the construction of these advanced topical patches. This review is meant for researchers and clinicians to consider utilising advanced topical patch systems in research and clinical trials toward localised interventions of NMSC.
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Affiliation(s)
| | | | | | | | - Sanjay Garg
- Centre for Pharmaceutical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (S.K.); (C.M.D.); (Y.S.); (A.H.)
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Wünscher SV, Spendel S, Nischwitz SP, Gualdi A, Avian A, Kamolz LP, Cambiaso-Daniel J. Do Sex-Specific Factors Influence the Surgical Treatment of Facial Skin Cancer? J Pers Med 2023; 13:1193. [PMID: 37623444 PMCID: PMC10456042 DOI: 10.3390/jpm13081193] [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: 07/01/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Facial skin cancer (FSC) is prone to incomplete excision due to the sophisticated anatomy and the aesthetic importance of the face. In this study, we sought to investigate to what extent sex-specific differences and other operation-, patient-, and cancer-specific factors influence the re-resection rate in FSC surgery, in order to provide personalized treatment strategies to patients. In this retrospective study, patients (>18 years) undergoing surgical excision of an FSC were enrolled. Each patient's demographic data, cancer location, the surgical team, primary and secondary surgeries were analyzed. Overall, 469 patients (819 surgeries) were included. The mean age was 69 ± 15 years. No significant association between sex-specific factors (surgeon's sex (OR: 1.09, 95% CI: 0.76-1.56) or patient's sex (OR: 0.85, 95% CI: 0.62-1.17), surgeon-patient sex concordance and discordance) and the likelihood of secondary surgery were found. However, healing by secondary intention (OR: 4.28; 95% CI: 1.94-9.45) and cancer location showed an increased re-resection rate. In conclusion, FSC surgery is a safe method unaffected by sex-specific factors, which had no impact on the re-resection rate. However, in further analysis, the likelihood of a re-resection was influenced by other factors such as healing by secondary intention and cancer location. This knowledge might be useful to provide an algorithm for personalized treatment strategies in the future.
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Affiliation(s)
- Sarah Victoria Wünscher
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Sebastian P Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Alessandro Gualdi
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Vita-Salute San Raffaele, 20132 Milan, Italy
- Milano Face Institute, 20146 Milan, Italy
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8036 Graz, Austria
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- Milano Face Institute, 20146 Milan, Italy
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Fandiño-Devia E, Santa-González GA, Klaiss-Luna MC, Guevara-Lora I, Tamayo V, Manrique-Moreno M. ΔM4: Membrane-Active Peptide with Antitumoral Potential against Human Skin Cancer Cells. MEMBRANES 2023; 13:671. [PMID: 37505037 PMCID: PMC10385147 DOI: 10.3390/membranes13070671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
Peptides have become attractive potential agents due to their affinity to cancer cells. In this work, the biological activity of the peptide ΔM4 against melanoma cancer cell line A375, epidermoid carcinoma cell line A431, and non-tumoral HaCaT cells was evaluated. The cytotoxic MTT assay demonstrates that ΔM4 show five times more activity against cancer than non-cancer cells. The potential membrane effect of ΔM4 was evaluated through lactate dehydrogenase release and Sytox uptake experiments. The results show a higher membrane activity of ΔM4 against A431 in comparison with the A375 cell line at a level of 12.5 µM. The Sytox experiments show that ΔM4 has a direct effect on the permeability of cancer cells in comparison with control cells. Infrared spectroscopy was used to study the affinity of the peptide to membranes resembling the composition of tumoral and non-tumoral cells. The results show that ΔM4 induces a fluidization effect on the tumoral lipid system over 5% molar concentration. Finally, to determine the appearance of phosphatidylserine on the surface of the cell, flow cytometry analyses were performed employing an annexin V-PE conjugate. The results suggest that 12.5 µM of ΔM4 induces phosphatidylserine translocation in A375 and A431 cancer cells. The findings of this study support the potential of ΔM4 as a selective agent for targeting cancer cells. Its mechanism of action demonstrated selectivity, membrane-disrupting effects, and induction of phosphatidylserine translocation.
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Affiliation(s)
- Estefanía Fandiño-Devia
- Chemistry Institute, Faculty of Exact and Natural Sciences, University of Antioquia, A.A. 1226, Medellin 050010, Colombia
| | - Gloria A Santa-González
- Grupo de Investigación e Innovación Biomédica, Facultad de Ciencias Exactas y Aplicadas, Instituto Tecnológico Metropolitano, A.A. 54959, Medellín 050010, Colombia
| | - Maria C Klaiss-Luna
- Chemistry Institute, Faculty of Exact and Natural Sciences, University of Antioquia, A.A. 1226, Medellin 050010, Colombia
| | - Ibeth Guevara-Lora
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 30-387 Krakow, Poland
| | - Verónica Tamayo
- Chemistry Institute, Faculty of Exact and Natural Sciences, University of Antioquia, A.A. 1226, Medellin 050010, Colombia
| | - Marcela Manrique-Moreno
- Chemistry Institute, Faculty of Exact and Natural Sciences, University of Antioquia, A.A. 1226, Medellin 050010, Colombia
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10
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Spanos S, Singh N, Laginha BI, Arnolda G, Wilkinson D, Smith AL, Cust AE, Braithwaite J, Rapport F. Measuring the quality of skin cancer management in primary care: A scoping review. Australas J Dermatol 2023; 64:177-193. [PMID: 36960976 PMCID: PMC10952799 DOI: 10.1111/ajd.14023] [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: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Bela I. Laginha
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - David Wilkinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
- National Skin Cancer CentresSouth BrisbaneQueenslandAustralia
| | - Andrea L. Smith
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Anne E. Cust
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
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11
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Current Utilization of Qualitative Methodologies in Dermatology: A Scoping Review. JID INNOVATIONS 2023; 3:100172. [PMID: 36891031 PMCID: PMC9986021 DOI: 10.1016/j.xjidi.2022.100172] [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: 04/30/2022] [Revised: 08/27/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
The focus of this review was to determine how qualitative methods are used in dermatology research and whether published manuscripts meet current standards for qualitative research. A scoping review of manuscripts published in English between January 1, 2016 and September 22, 2021 was conducted. A coding document was developed to collect information on authors, methodology, participants, research theme, and the presence of quality criteria as outlined by the Standards for Reporting Qualitative Research. Manuscripts were included if they described original qualitative research about dermatologic conditions or topics of primary interest to dermatology. An adjacency search yielded 372 manuscripts, and after screening, 134 met the inclusion criteria. Most studies utilized interviews or focus groups, and researchers predominantly selected participants on the basis of disease status, including over 30 common and rare dermatologic conditions. Research themes frequently included patient experience of disease, development of patient-reported outcomes, and descriptions of provider and caregiver experiences. Although most authors explained their analysis and sampling strategy and included empirical data, few referenced qualitative data reporting standards. Missed opportunities for qualitative methods in dermatology include examination of health disparities, exploration of surgical and cosmetic dermatology experiences, and determination of the lived experience of and provider attitudes toward diverse patient populations.
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12
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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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13
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Veldhuizen IJ, Schroen E, Lee EH, Kurtansky NR, Dusza SW, van der Hulst RRWJ, Pusic AL, Hoogbergen MM. Sun Protection Behavior Following Skin Cancer Resection and Reconstruction. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1401-1406. [PMID: 33611743 DOI: 10.1007/s13187-021-01971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 06/12/2023]
Abstract
Increased exposure to ultraviolet radiation (UVR) is associated with an increased risk of nonmelanoma skin cancer. Cutaneous surgery can be negatively influenced by UVR, causing delayed wound healing, hyperpigmentation of the scar, and an increased incidence of additional skin cancers. By changing sun protection behavior, these risks can be limited. Therefore, this study evaluates changes in patients' sun protective behavior after Mohs micrographic surgery (MMS). Patients undergoing MMS between December 2017 and November 2019 were included. Patients were asked to complete the FACE-Q Skin Cancer - Sun Protection Behavior checklist before and 3 months and 1 year post-surgery. A total of 125 patients completed the pre-operative and 3-months post-operative checklists, and 89 (71.2%) completed the 1-year post-operative checklist. Reported sun protective behaviors increased post-surgery at all time points (p < 0.001). Patients with a prior history of facial skin cancer demonstrated a larger increase in sun protection behaviors after surgery than patients without a history of facial skin cancer (p = 0.04). Patients with defects located on the ear or scalp demonstrated a lesser increase in sun protection behaviors than patients with defects located in more conspicuous areas as the face (p = 0.02). Our study demonstrates a change in sun protection behavior, with an increase in sun protection behavior over time in patients after MMS. However, more improvement is possible. Targeted counseling can increase sun protection behavior in patients without a history of facial skin cancer and patients with skin cancer located on the ears or scalp.
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Affiliation(s)
- I J Veldhuizen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Plastic and Reconstructive Surgery, Nutrim, Maastricht University Medical Center, Maastricht, the Netherlands
| | - E Schroen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - E H Lee
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N R Kurtansky
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S W Dusza
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Nutrim, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A L Pusic
- Plastic and Reconstructive Surgery Division, Brigham and Women's Hospital, Boston, MA, USA
| | - M M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands.
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14
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Cowen E, Veldhuizen I, Klassen A, Cano S, Dusza S, Nehal K, Pusic A, Lee E. Sun protection behaviour checklist for targeted counselling in skin cancer patients. Australas J Dermatol 2022; 63:392-394. [PMID: 35460573 PMCID: PMC9946314 DOI: 10.1111/ajd.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- E.A. Cowen
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - I.J. Veldhuizen
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Plastic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - A.F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - S.J. Cano
- Modus Outcomes, Letchworth Garden City, UK
| | - S.W. Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K.S. Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A.L. Pusic
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - E.H. Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Iglesias-Puzas Á, García-González V, Conde-Taboada A, López-Bran E. Fear of cancer recurrence in patients with non-metastatic melanoma: Spanish validation and disease-related factors. Australas J Dermatol 2022; 63:e312-e319. [PMID: 35904493 DOI: 10.1111/ajd.13907] [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: 05/27/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION It is essential for clinicians to understand the phenomenon of fear of cancer recurrence (FCR) in order to understand the psychological impact it has on patients with melanoma. OBJECTIVES To validate an FCR questionnaire in Spanish for patients with non-metastatic melanoma and to describe the clinical and demographic variables associated with FCR in these patients. METHODS Patients diagnosed with non-metastatic melanoma were selected. The questionnaire was translated and adapted to Spanish following international guidelines. The internal consistency, construct validity, and temporal stability of the questionnaire were analysed using Cronbach's alpha, confirmatory factor analysis, and test-retest reliability, respectively. Following this, the correlation between FCR scores and the study variables was evaluated. RESULTS A total of 123 patients were included in the study. The translated and adapted questionnaire showed high reliability (overall Cronbach's alpha 0.834), temporal stability (intraclass correlation coefficient 0.8), and unidimensionality. The mean FCR score was 16.1 ± 6.7. The highest FCR scores were observed in women and young patients (p < 0.01). Patients with a personal history of cancer, facial melanoma, or skin graft reconstruction also obtained a high FCR score (p < 0.05). No differences were found between FCR and other tumour characteristics, such as the Breslow index or the time since diagnosis. CONCLUSIONS This validated questionnaire is suitable for evaluating FCR. We also identified factors that tend to increase FCR scores, thus allowing clinicians to identify patients at risk and start preventive measures.
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Affiliation(s)
- Álvaro Iglesias-Puzas
- Dermatology Department, Hospital Universitario Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Víctor García-González
- Dermatology Department, Hospital Universitario Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Alberto Conde-Taboada
- Dermatology Department, Hospital Universitario Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Eduardo López-Bran
- Dermatology Department, Hospital Universitario Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
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16
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3D Surface Imaging Technology for Objective Automated Assessment of Facial Interventions: a Systematic Review. J Plast Reconstr Aesthet Surg 2022; 75:4264-4272. [DOI: 10.1016/j.bjps.2022.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/22/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022]
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17
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Veldhuizen IJ, Brouwer P, Aleisa A, Kurtansky NR, Dusza SW, Nehal KS, Hoogbergen MM, van der Hulst RR, Lee EH. Nasal skin reconstruction: Time to rethink the reconstructive ladder? J Plast Reconstr Aesthet Surg 2022; 75:1239-1245. [PMID: 34903490 PMCID: PMC8976754 DOI: 10.1016/j.bjps.2021.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/17/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nasal scarring can compromise aesthetics and function given its complex three-dimensional structure and central location. This study aimed to measure patients' satisfaction after reconstruction for nasal defects following Mohs micrographic surgery. METHODS Patients presenting with nasal nonmelanoma skin cancer at Memorial Sloan Kettering Cancer Center New York, USA and Catharina Hospital Eindhoven, Netherlands from April 2017 to November 2019 were asked to participate. Reconstruction type, complications, and patients satisfaction were assessed. Patients completed the FACE-Q Skin Cancer - Satisfaction with Facial Appearance scale (preoperative and 1-year postoperative) and the Appraisal of Scars scale (1-year postoperative). RESULTS A total of 128 patients completed the preand postoperative scales. There were 35 (27%) surgical defects repaired with primary closures, 71 (55.5%) with flaps, and 22 (17.2%) with full-thickness skin grafts (FTSG). Patients that underwent a flap or FTSG reconstruction had higher scar satisfaction scores than primary closures (p = 0.03). A trend was seen with patients following flap reconstructions scoring 7.8 points higher than primary closures and patients with upper nose defects scoring 6.4 points higher than lower nose defects. Males were significantly more satisfied than females. No significant difference was observed in the preoperative and postoperative facial appearance scores between the three groups (p = 0.39). CONCLUSION Patients are more satisfied in the long term with their scars after flap reconstructions compared to primary closures. Therefore, nasal skin reconstruction may not follow the traditional reconstructive ladder and more complex approaches may lead to higher long-term scar satisfaction.
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Affiliation(s)
- Inge J. Veldhuizen
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Plastic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Philip Brouwer
- Department of Plastic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Abdullah Aleisa
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Stephen W. Dusza
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kishwer S. Nehal
- Dermatology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - René R.W.J. van der Hulst
- 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, NY, USA
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18
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Ruiz ES, Veldhuizen IJ, Abdullah A, Rossi A, Nehal KS, Schmults C, Waldman A, Lee EH. Impact of COVID-19 delays on skin cancer worry and Mohs micrographic surgery for keratinocytic carcinoma. J Am Acad Dermatol 2021; 87:878-880. [PMID: 34875305 PMCID: PMC8642832 DOI: 10.1016/j.jaad.2021.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 11/19/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Emily Stamell Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Inge J Veldhuizen
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aleisa Abdullah
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chrysalyne Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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19
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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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20
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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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21
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Starkings R, Shilling V, Jenkins V, Fallowfield L. A structured review of quality of life in advanced and high‐risk cutaneous squamous cell carcinoma shows the need for more studies and better measures. SKIN HEALTH AND DISEASE 2021; 1:e39. [PMID: 35663134 PMCID: PMC9060136 DOI: 10.1002/ski2.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 12/19/2022]
Affiliation(s)
- R. Starkings
- Sussex Health Outcomes Research and Education in Cancer (SHORE‐C) Brighton and Sussex Medical School University of Sussex Brighton UK
| | - V. Shilling
- Sussex Health Outcomes Research and Education in Cancer (SHORE‐C) Brighton and Sussex Medical School University of Sussex Brighton UK
| | - V. Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE‐C) Brighton and Sussex Medical School University of Sussex Brighton UK
| | - L. Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE‐C) Brighton and Sussex Medical School University of Sussex Brighton UK
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22
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Wu H, Xu H, Jia D, Li T, Xia L. METTL3-induced UCK2 m 6A hypermethylation promotes melanoma cancer cell metastasis via the WNT/β-catenin pathway. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1155. [PMID: 34430596 PMCID: PMC8350655 DOI: 10.21037/atm-21-2906] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023]
Abstract
Background Melanoma is a highly aggressive, malignant skin tumor with a statistically high mortality rate. N6-methyladenosine (m6A) modification is involved in a variety of biological processes, including tumorigenesis. m6A modifications regulate the fate and functions of RNA, such as mRNA stability, nuclear processing, transport, localization, translation, primary microRNA (miRNA) processing, and RNA-protein interactions. Several members (including METTL3, METTL14, FTO, ALKBH5, and YTHDF2) are actively involved in a variety of human cancers. However, the basic mechanism of the involvement of uridine cytidine kinase 2 (UCK2) in melanoma metastasis has not been studied. UCK2 is upregulated in a variety of malignancies. However, the complex molecular mechanisms and therapeutic effects of UCK2 in melanoma remain unclear. Methods The expression of UCK2 was evaluated by qRT-PCR. The effects of UCK2 on the biological characteristics of PC cells were investigated on the basis of loss-of-function analyses. Immunoprecipitation-qPCR (MeRIP-qPCR) was performed to identify the m6A targeted effect of UCK2 in melanoma cancer. Results Based on the bioinformatics analysis in this study, up-regulation of UCK2 could be essential in melanoma cancer, and associated with poor survival. Furthermore, the m6A modification regulated by METTL3 led to UCK2 increased messenger RNA (mRNA) stability in melanoma cancer. Functional and mechanistic experiments indicated that UCK2 enhanced the metastasis of melanoma cancer cells through the WNT/β-catenin pathway. Conclusion In this study, we found that m6A-METTL3 axis induced abnormal UCK2 expression plays a role in melanoma metastasis by enhancing the Wnt/β-catenin pathway, which may provide new clues for melanoma metastasis. It also provides a potential target for the prevention and treatment of melanoma.
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Affiliation(s)
- Hao Wu
- Department of Bone and Soft-Tissue Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Haochao Xu
- Department of Bone and Soft-Tissue Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Dongdong Jia
- Department of Bone and Soft-Tissue Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Tao Li
- Department of Bone and Soft-Tissue Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Liming Xia
- Department of Bone and Soft-Tissue Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
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23
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Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott PD. Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:1035-1044. [PMID: 34292310 DOI: 10.1001/jamaoto.2021.1563] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Aesthetic outcomes are key determinants of psychosocial functioning among surgically treated patients with head and neck cancer (HNC); however, long-term aesthetic outcomes after microvascular free tissue transfer (MFTT) are not well described. Objective To examine risk factors for impaired long-term aesthetic satisfaction and appearance-related psychosocial functioning after HNC ablation with MFTT. Design, Setting, and Participants A cross-sectional, web-based survey was conducted at an academic tertiary care center. A total of 228 individuals who underwent MFTT between January 1, 2015, and December 31, 2019, for treatment of HNC were included. The study was conducted from November 1, 2020, through January 15, 2021. Exposures Head and neck cancer ablation with MFTT. Main Outcomes and Measures Patient-reported outcomes were assessed via Aesthetic FACE-Q scales. The primary objective was aesthetic satisfaction determined by the Satisfaction With Facial Appearance scale. Secondarily, the Appearance-Related Psychosocial Distress, Psychological Function, and Social Function scales were used to assess appearance-related psychosocial functioning. Patients were stratified by demographic, disease, surgical, and postoperative characteristics. Survey scores on a 100-point scale were compared and subjected to univariable and multivariable linear regression. Results A total of 124 of 228 patients (54.4%) completed surveys a median of 34.4 months after MFTT (interquartile range, 22.6-48.8). Most responders (79 [63.7%]) were men with advanced cancer of the oral cavity or skin, reconstructed with anterolateral thigh or osteocutaneous fibula free flaps. Nonresponders had no significant differences in baseline characteristics. The Satisfaction With Facial Appearance score was independently lower among patients who received osteocutaneous flaps (regression coefficient, -10.6 points, 95% CI, -20.4 to -0.8 points) and/or adjuvant (chemo)radiotherapy (regression coefficient, -6.9 points; 95% CI, -13.8 to -0.1 points). Impaired appearance-related psychosocial functioning was independently associated with female sex, a history of anxiety or depression, osteocutaneous flaps, prolonged tube feeding requirements, and any recurrent or persistent disease. After adjustment for covariates, each 1-point increase in the Satisfaction With Facial Appearance score independently estimated improved appearance-related psychosocial functioning as determined by the Appearance-Related Psychosocial Distress scale (regression coefficient, -0.5 points; 95% CI, -0.7 to -0.4 points), Psychological Function scale (regression coefficient, 0.4 points; 95% CI, 0.3 to 0.5 points), and Social Function scale (regression coefficient, 0.4 points; 95% CI, 0.3 to 0.6 points). Conclusions and Relevance The findings of this cross-sectional, web-based survey study suggest that osteocutaneous reconstruction and adjuvant therapy independently increase the risk of poor patient-reported long-term aesthetic satisfaction, which correlated with impaired appearance-related psychosocial functioning. Aesthetic outcomes appear to be a priority to address in patients with HNC undergoing MFTT.
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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
| | - Neil Patel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco
| | - Chase M Heaton
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Andrea M Park
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - P Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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24
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Patient Outcomes and Satisfaction After Mohs Micrographic Surgery in Patients With Nonmelanoma Skin Cancer. Dermatol Surg 2021; 47:1190-1194. [PMID: 34148996 DOI: 10.1097/dss.0000000000003106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Quality in medicine is increasingly being measured through patient-reported outcome measures. Given the rising incidence and costs for nonmelanoma skin cancer (NMSC) treatment, it is imperative to define quality measures specific to dermatologic surgery. OBJECTIVE This study aims to evaluate patient-reported outcomes and satisfaction with Mohs micrographic surgery (MMS) together with patient and tumor factors to better define their use in developing treatment strategies and quality measures. METHODS AND MATERIALS A prospective study was conducted among 226 patients undergoing MMS for treatment of NMSC. Patient demographics, quality of life, functional status, satisfaction, and prognostic factors were gathered. Postoperative outcomes were measured at 1 month and included patient-reported problems and provider-reported complications. Relationships between patient factors and outcomes were evaluated through statistical analysis. RESULTS Average patient satisfaction in the domain of general satisfaction of the Patient Satisfaction Questionnaire-18 was 4.34 of 5. General patient satisfaction did not differ across age, final defect size, sex, or prognostic scores. At 1-month postoperatively, 97 percent of patients expressed willingness to undergo future MMS if indicated. CONCLUSION Patients are generally satisfied with MMS for treatment of NMSC. Specific patient factors that may affect satisfaction include smoking status and anticoagulation use.
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25
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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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26
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Blood Z, Tran A, Caleo L, Saw R, Dieng M, Shackleton M, Soyer HP, Arnold C, Mann GJ, Morton RL. Implementation of patient-reported outcome measures and patient-reported experience measures in melanoma clinical quality registries: a systematic review. BMJ Open 2021; 11:e040751. [PMID: 33574144 PMCID: PMC7880114 DOI: 10.1136/bmjopen-2020-040751] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To identify patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in clinical quality registries, for people with cutaneous melanoma, to inform a new Australian Melanoma Clinical Outcomes Registry; and describe opportunities and challenges of routine PROM/PREM collection, especially in primary care. DESIGN Systematic review. PRIMARY AND SECONDARY OUTCOME MEASURES Which PROMs and PREMs are used in clinical quality registries for people with cutaneous melanoma, how they are collected, frequency of collection, participant recruitment methods and funding models for each registry. RESULTS 1134 studies were identified from MEDLINE, PreMEDLINE, Embase, PsychInfo, Cochrane Database of Abstracts of Reviews of Effects databases and TUFTS Cost-Effectiveness Analysis Registry, alongside grey literature, from database inception to 5th February 2020. Following screening, 14 studies were included, identifying four relevant registries: Dutch Melanoma Registry, Adelphi Real-World Disease-Specific Programme (Melanoma), Patient-Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship Registry, and Cancer Experience Registry. These used seven PROMs: EuroQol-5 Dimensions, Functional Assessment of Cancer-General (FACT-G) and FACT-Melanoma (FACT-M), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30 (EORTC QLQ-C30), Fatigue Assessment Scale Hospital Anxiety and Depression Scale, Patient-Reported Outcome Measures Information System-29 and one PREM; EORTC QLQ-Information Module 26. PROMs/PREMs in registries were reported to improve transparency of care; facilitate clinical auditing for quality assessment; enable cost-effectiveness analyses and create large-scale research platforms. Challenges included resource burden for data entry and potential collection bias toward younger, more affluent respondents. Feedback from patients with melanoma highlighted the relevance of PROMs/PREMs in assessing patient outcomes and patient experiences. CONCLUSIONS Clinical registries indicate PROMs/PREMs for melanoma care can be incorporated and address important gaps, however cost and collection bias may limit generalisability. PROSPERO REGISTRATION NUMBER CRD42018086737.
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Affiliation(s)
- Zachary Blood
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Caleo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Saw
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Shackleton
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Chris Arnold
- Skin Health Institute, Melbourne, Victoria, Australia
- BioGrid Australia, Parkville, Victoria, Australia
| | - Graham J Mann
- Western Clinical School, Westmead Millennium Institute, The University of Sydney, Sydney, New South Wales, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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27
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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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Patient Expectations Influence Postoperative Facial Satisfaction Measured by the FACE-Q Skin Cancer Module: A Pilot Study. Dermatol Surg 2021; 46:1113-1115. [PMID: 31306272 DOI: 10.1097/dss.0000000000002014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Pradarelli JC, Delisle M, Briggs A, Smink DS, Yule S. Identifying Naturalistic Coaching Behavior Among Practicing Surgeons in the Operating Room. Ann Surg 2021; 273:181-186. [PMID: 31425283 DOI: 10.1097/sla.0000000000003368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify examples of naturalistic coaching behavior among practicing surgeons operating together by analyzing their intraoperative discussion. BACKGROUND Opportunities to improve surgical performance are limited for practicing surgeons; surgical coaching is one strategy to address this need. To develop peer coaching programs that integrate with surgical culture, a better understanding is needed of how surgeons routinely discuss operative performance. METHODS As part of a "co-surgery" quality improvement program, 20 faculty surgeons were randomized into 10 dyads who performed an operation together. Discourse analysis was conducted on transcribed intraoperative discussions. Themes were coded using an existing framework of surgical coaching principles (self-identified goals, collaborative analysis, constructive feedback, peer learning support) and surgical coaching content (technical skills, nontechnical skills). Coaching principles were cross-referenced with coaching content; c-coefficient measured the strength of association between pairs of themes. RESULTS Overall, 44 unique coaching examples were identified in 10 operations. Of the 4 principles of surgical coaching, only self-identified goals and collaborative analysis were identified consistently. Self-identified goals were most associated with discussions regarding technical skills of "tissue exposure," "flow of operation," and "instrument handling" and the nontechnical skill "situation awareness." Collaborative analysis was most associated with discussions regarding technical skills of "respect for tissue" and "flow of operation" and nontechnical skills of "communication and teamwork." CONCLUSIONS In naturalistic discussions between practicing surgeons in the operating room, numerous examples of unprompted coaching behavior were identified that target intraoperative performance. Prominent coaching gaps-constructive feedback and peer learning support-were also observed. Surgical coach trainings should address these gaps.
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Affiliation(s)
- Jason C Pradarelli
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
| | - Megan Delisle
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Surgery, University of Manitoba, Winnipeg, MB
| | - Alexandra Briggs
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA
| | - Steven Yule
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA
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30
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Kamran R, Longmire NM, Rae C, Riff KWYW, Forrest CR, O’Hara J, Bulstrode N, Klassen AF. Concepts Important to Patients With Facial Differences: A Qualitative Study Informing a New Module of the FACE-Q for Children and Young Adults. Cleft Palate Craniofac J 2020; 58:1020-1031. [DOI: 10.1177/1055665620969589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The concepts important to children and young adults who undergo treatments for facial differences are not well-defined. Measurement of treatment outcomes from the patient’s perspective is necessary to ensure goals of treatment are met. We aimed to identify concepts important to children and young adults with facial differences through a qualitative study. Design: An interpretive description qualitative approach was followed. Semistructured interviews were conducted, transcribed verbatim, and coded using a line-by-line approach. Qualitative analysis led to the development of a conceptual framework of outcomes important to patients. Setting: Interviews were conducted in Canada and the United Kingdom at home, by telephone, or in the hospital. Participants: Participants (N = 72) were recruited between May and June 2014 from craniofacial clinics at the Hospital for Sick Children (Toronto) and Great Ormond Street Hospital (London). Participants included anyone with a visible and/or functional facial difference aged 8 to 29 years and fluent in English, excluding patients with a cleft. The sample included 38 females and 34 males, with a mean age of 13.9 years, and included 28 facial conditions (11 facial paralysis, 18 ear anomalies, 26 skeletal conditions, and 17 soft tissue conditions). Results: Analysis led to identification of important concepts within 4 overarching domains: facial appearance, facial function, adverse effects of treatment, and health-related quality of life (psychological, social, and school function). Conclusions: Our study provides an understanding of concepts important to children and young adults with facial differences.
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Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen W. Y. Wong Riff
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R. Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Justine O’Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Neil Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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31
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Chen LW, Razavi CR, Hong H, Fondong A, Ranganath R, Khatri S, Mydlarz WK, Mathur A, Ishii M, Nellis J, Shaear M, Tufano RP, Russell JO. Cosmetic outcomes following transoral versus transcervical thyroidectomy. Head Neck 2020; 42:3336-3344. [DOI: 10.1002/hed.26383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lena W. Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Christopher R. Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Hanna Hong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Akeweh Fondong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Rohit Ranganath
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Surya Khatri
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Wojciech K. Mydlarz
- Division of Head and Neck Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Aarti Mathur
- Division of Surgical Oncology, Department of Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Masaru Ishii
- Division of Rhinology and Sinus, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jason Nellis
- Division of Head and Neck Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Mohammad Shaear
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Ralph P. Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jonathon O. Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD USA
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32
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Lee EH, Klassen AF, Cano SJ, Pusic AL. Re: "Development of a Patient-Reported Outcome Measure for Mohs Reconstruction" by Kavanagh and Christophel. Facial Plast Surg Aesthet Med 2020; 22:397-398. [PMID: 32614610 DOI: 10.1089/fpsam.2020.0264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stefan J Cano
- Modus Outcomes, Letchworth Garden City, United Kingdom
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Dey JK, Ishii LE, Boahene KDO, Byrne PJ, Ishii M. Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology. JAMA FACIAL PLAST SU 2020; 21:518-525. [PMID: 31670742 DOI: 10.1001/jamafacial.2019.1072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Objectively measuring how Mohs defect reconstruction changes casual observer attention has important implications for patients and facial plastic surgeons. Objective To use eye-tracking technology to objectively measure the ability of Mohs facial defect reconstruction to normalize facial attention. Design, Setting, and Participants This observational outcomes study was conducted at an academic tertiary referral center from January to June 2016. An eye-tracking system was used to record how 82 casual observers directed attention to photographs of 32 patients with Mohs facial defects of varying sizes and locations before and after reconstruction as well as 16 control faces with no facial defects. Statistical analysis was performed from November 2018 to January 2019. Main Outcomes and Measures First, the attentional distraction caused by facial defects was quantified in milliseconds of gaze time using eye tracking. Second, the eye-tracking data were analyzed using mixed-effects linear regression to assess the association of facial defect reconstruction with normalized facial attention. Results The 82 casual observers (63 women and 19 men; mean [SD] age, 34 [12] years) viewed control faces in a similar and consistent fashion, with most attention (65%; 95% CI, 62%-69%) directed at the central triangle, which includes the eyes, nose, and mouth. The eyes were the most visually important feature, capturing a mean of 60% (95% CI, 57%-64%) of fixation time within the central triangle and 39% (95% CI, 36%-43%) of total observer attention. The presence of Mohs defects was associated with statistically significant alterations in this pattern of normal facial attention. The larger the defect and the more centrally a defect was located, the more attentional distraction was observed, as measured by increased attention on the defect and decreased attention on the eyes, ranging from 729 (95% CI, 526-931) milliseconds for small peripheral defects to 3693 (95% CI, 3490-3896) milliseconds for large central defects. Reconstructive surgery was associated with improved gaze deviations for all faces and with normalized attention directed to the eyes for all faces except for those with large central defects. Conclusions and Relevance Mohs defects are associated with altered facial perception, diverting attention from valuable features such as the eyes. Reconstructive surgery was associated with normalized attentional distraction for many patients with cutaneous Mohs defects. These data are important to patients who want to know how reconstructive surgery could change the way people look at their face. The data also point to the possibility of outcomes prediction based on facial defect size and location before reconstruction. Eye tracking is a valuable research tool for outcomes assessment that lays the foundation for understanding how reconstructive surgery may change perception and normalize facial deformity.
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Affiliation(s)
- Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D O Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Thompson AR, Sewards I, Baker SR. Cancer and changes in facial appearance: A meta-ethnography of qualitative studies. Br J Health Psychol 2020; 25:129-151. [PMID: 31898403 PMCID: PMC7003786 DOI: 10.1111/bjhp.12398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/25/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Living with an altered facial appearance as a result of treatment for cancer requires considerable psychological adjustment. As such it is essential that health care professionals understand the lived experience of people affected. This systematic review provides a meta-ethnography of studies that have explored the experience of changed facial appearance as a result of cancer. METHODS A search of four databases (Web of Science, CINAHL, PsycInfo, and Scopus) took place using terms relating to qualitative research, cancer, and changed facial appearance. Thirteen studies were identified, appraised, and included in the synthesis. The findings and interpretations within the studies were subject to meta-ethnography procedures so as to elicit novel cross-cutting themes. FINDINGS The experience of changed facial appearance after cancer was clustered into three contexts. In the context of the disease, subthemes were the primacy of survival, the changing relationship with the disease, and the impact of the care team on the experience of changed appearance. In the context of the social world, subthemes were positive reactions, negative reactions, and coping strategies. In the context of the self, subthemes were the self under attack, self-to-self relating, the self in the world, and rebuilding the self. CONCLUSIONS The findings indicate that health care professionals must conduct holistic assessments, so as to fully recognize and where necessary address the impact upon self. The meta-ethnography shows that the experience of facial appearance change following cancer is complex and requires awareness of a number of theoretical areas including identity construction, social support, stigmatization, and the specific literature on visible difference. Statement of contribution What is already known on this subject? Changed facial appearance after cancer can cause significant social difficulties and impact on the sense of self. The experience of managing the specific dual challenges of cancer and altered facial appearance is not clearly understood. Recent studies that have focused specifically on the experience of changes in appearance after cancer have been limited in scope and transferability. What does this study add? To our knowledge, this is the first meta-ethnography to bring together the literature on the impact of altered facial appearance following cancer. Patients may feel unable to talk about appearance with health care professionals because it is seen as a frivolous issue. Clinicians should facilitate open, person-centred opportunities for patients to discuss the impact of changed appearance and where necessary facilitate access to support.
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Affiliation(s)
- Andrew R. Thompson
- Clinical Psychology UnitDepartment of PsychologyUniversity of SheffieldUK
| | - Iona Sewards
- Clinical Psychology UnitDepartment of PsychologyUniversity of SheffieldUK
- Present address:
Rotherham General HospitalUK
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Lamprell K, Braithwaite J. Reading Between the Lines: A Five-Point Narrative Approach to Online Accounts of Illness. THE JOURNAL OF MEDICAL HUMANITIES 2019; 40:569-590. [PMID: 30982939 PMCID: PMC6851276 DOI: 10.1007/s10912-019-09553-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The successful delivery of patient-centered care hinges on clinical affiliation for patients' personal needs and experiences. Narrative competence is a mode of thinking and set of actions that widens the clinical gaze beyond logico-scientific cognition. In this article, we investigate a tool that enables clinicians to rehearse their skills in narrative competence. We apply the narrative competence framework developed by the founding practitioners of narrative medicine to personal accounts of illness and patienthood published on the Internet. We describe our use of the five-point framework in the close reading of 214 accounts by people with the life-threatening skin cancer melanoma.
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Affiliation(s)
- Klay Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6 | 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6 | 75 Talavera Road, Sydney, NSW, 2109, Australia.
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36
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Liao D, Ishii LE, Chen LW, Chen J, Juarez M, Darrach HM, Kumar AR, Russell JO, Tufano RP, Ishii M. Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery. Laryngoscope 2019; 130:1603-1608. [PMID: 31660610 DOI: 10.1002/lary.28305] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/01/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Measure attentional distraction of neck scars after open neck surgery compared to transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) or transoral endoscopic parathyroidectomy via a vestibular approach (TOEPVA) using eye-tracking technology. METHODS Casual observers viewed facial images of patients who underwent open neck surgery, TOETVA/TOEPVA, or no surgery (controls). An eye-tracking monitor recorded eye fixations in real time. Multivariate Hotelling's analysis followed by post-hypothesis testing compared fixation durations for predefined regions of interest, including the eyes, nose, mouth, neck, and remaining face between open neck surgery patients, transoral neck surgery patients, and controls. RESULTS One hundred forty observers completed the experiment. The majority of their attention was directed towards the central triangle (eyes, nose, mouth). On multivariate analysis, distribution of attention was significantly different on the faces of those who underwent open neck surgery versus TOETVA/TOEPVA (T2 = 43.66; F[32,131] = 14.5389, P < .0001). Observers attended significantly more to the neck (0.20 seconds, P < .0001; 95% CI, 0.13, 0.26 s) and less to the peripheral face (-0.24 seconds, P = .0031; 95% CI, -0.39, -0.08 s) of open neck surgery patients. In patients who followed up months after surgery, significant differences persisted (T2 = 13.97; F[3451] = 4.6377, P = .0033). By contrast, fixation patterns for TOETVA/TOEPVA patients were not significantly different from controls (T2 = 5.59, F[31,186] = 1.8602, P = .1345). Observer race and gender did not significantly affect attention to neck scars. CONCLUSION Scars following open neck surgery draw attention in casual observers. This attentional distraction is prevented in TOETVA/TOEPVA patients due to the absence of a scar, even months after surgery. Moreover, visual processing of TOETVA/TOEPVA patients' faces is similar to that of controls. These data support the effectiveness of transoral neck surgery in giving patients a cosmetic result that does not distract the attention of observers. LEVEL OF EVIDENCE NA Laryngoscope, 130:1603-1608, 2020.
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Affiliation(s)
- David Liao
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lena W Chen
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jonlin Chen
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Michelle Juarez
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Halley M Darrach
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Anisha R Kumar
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Khoshab N, Vaidya TS, Dusza S, Nehal KS, Lee EH. Factors contributing to cancer worry in the skin cancer population. J Am Acad Dermatol 2019; 83:626-628. [PMID: 31585145 DOI: 10.1016/j.jaad.2019.09.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Nima Khoshab
- University of California, Irvine, School of Medicine, Irvine, California
| | - Toral S Vaidya
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
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Patient-reported Aesthetic Satisfaction following Facial Skin Cancer Surgery Using the FACE-Q Skin Cancer Module. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2423. [PMID: 31942391 PMCID: PMC6908379 DOI: 10.1097/gox.0000000000002423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/02/2019] [Indexed: 11/25/2022]
Abstract
Over 5 million basal and squamous cell skin cancers are diagnosed each year. Seventy to 80% of these cancers occur in the head and neck region, for which surgical excision is the standard treatment. As patient satisfaction and quality of life are among the most important outcomes in plastic and reconstructive surgery, understanding patient perception of aesthetic postoperative outcome is critical. The objective of this study was to assess aesthetic satisfaction following facial skin cancer surgery using the FACE-Q Skin Cancer Module in the context of sociodemographic and clinical factors. Methods This is a single-center, cross-sectional study in a tertiary care cancer setting of patients who underwent facial skin cancer surgery from March 1, 2016, to March 31, 2018. Patients completed the FACE-Q Skin Cancer Satisfaction with Facial Appearance and Appraisal of Scar scales postoperatively, between May 21, 2018, and October 1, 2018. Results Patients completed the Satisfaction with Facial Appearance (n = 405) and Appraisal of Scar scales (n = 408) postoperatively (response rate 39%). Lower postoperative facial appearance and scar satisfaction scores were associated with female gender, younger age (<65 years), surgery location on the lip or nose, repair by flap or graft, and greater defect size. Linear regression models established that younger age, female gender, nose location, and flap repair were independently predictive of lower aesthetic satisfaction. Conclusions Sociodemographic factors, central facial location, and repair type strongly contribute to aesthetic satisfaction following facial skin cancer surgery. This patient-reported data may guide counseling regarding postoperative aesthetic outcome and inform patient expectations.
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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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40
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Venning VL, Moreno-Bonilla G, Stewart TJ, Lee S, Fernandez-Peñas P. Increased collaboration between Mohs and plastic surgeons in the surgical management of skin cancer in Australia. Australas J Dermatol 2019; 61:85-87. [PMID: 31292946 DOI: 10.1111/ajd.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Victoria L Venning
- The Skin Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Gilberto Moreno-Bonilla
- The Skin Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Thomas J Stewart
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Simon Lee
- The Skin Hospital, Sydney, NSW, Australia
| | - Pablo Fernandez-Peñas
- The Skin Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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Liu P, Du R, Yu X. LncRNA HAND2-AS1 overexpression inhibits cancer cell proliferation in melanoma by downregulating ROCK1. Oncol Lett 2019; 18:1005-1010. [PMID: 31423160 PMCID: PMC6607374 DOI: 10.3892/ol.2019.10402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/01/2019] [Indexed: 01/20/2023] Open
Abstract
Long non-coding (lnc)RNA heart and neural crest derivatives expressed 2-antisense RNA 1 (HAND2-AS1), an lncRNA antisense transcript adjacent to the heart and neural crest derivatives expressed 2 protein (HAND2), inhibits the development of several types of cancer; however, its role in melanoma is currently unknown. In the present study, it was revealed that lncRNA HAND2-AS1 was downregulated, whereas Rho-associated protein kinase 1 (ROCK1) mRNA was upregulated in tumor tissues when compared with the healthy tissues of patients with melanoma. Expression levels of lncRNA HAND2-AS1 and ROCK1 were inversely correlated in tumor tissues, but not in healthy tissues. LncRNA HAND2-AS1 expression levels were affected by tumor thickness, but not by tumor metastasis. LncRNA HAND2-AS1 overexpression led to inhibited melanoma cancer cell proliferation and an increased expression level of ROCK1. ROCK1 overexpression caused no evident effects on lncRNA HAND2-AS1 expression, but promoted cancer cell proliferation and decreased the effects of lncRNA HAND2-AS1 overexpression on cancer cell proliferation. Thus, it is possible that lncRNA HAND2-AS1 overexpression leads to inhibited cancer cell proliferation in melanoma cells through the downregulation of ROCK1.
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Affiliation(s)
- Pengcheng Liu
- Department of Hand and Pediatric Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.,Jilin Province Key Laboratory of Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin 130021, P.R. China
| | - Ruili Du
- Department of Clinical Laboratory, The Second Hospital of Changchun City, Changchun, Jilin 130022, P.R. China
| | - Xin Yu
- Department of Hand and Pediatric Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.,Jilin Province Key Laboratory of Tissue Repair, Reconstruction and Regeneration, Changchun, Jilin 130021, P.R. China
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Venning VL, Thomas CL, Consuegra Romero G, Castro Gutiérrez B, St George G, Fernandez-Peñas P. Keratinocyte carcinoma as a chronic disease in Australia and Spain: The importance of avoidance of perceived visible scars. Australas J Dermatol 2019; 60:284-287. [PMID: 30968391 DOI: 10.1111/ajd.13050] [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] [Received: 11/05/2018] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Keratinocyte cancer impacts health-related quality of life (HRQL). Disease progression and treatment can lead to adverse physical and psychosocial consequences. The skin cancer index (SCI) is a validated tool with higher scores reflecting greater HRQL. Our objectives were to assess and compare the impact of keratinocyte cancer using the SCI in two diverse populations. METHODS A total of 120 patients were prospectively recruited from dermatology clinics in Sydney, Australia, and Santander, Spain, providing demographics and completing the SCI. RESULTS About 61.1% of Australians reported ≥2 skin cancers (vs 20% P = <0.001), 44.4% resulting visible scars (vs 14.8% P = <0.001). Visible scars were associated with poorer HRQL, across total SCI (68.3 vs 81.5 P = <0.001), social (76.0 vs 86.7 P = 0.003) and emotional (54.2 vs 69.7 P = 0.003) domains. Interestingly, perceived visible scars were not associated with appearance scores. The Spanish population reported greater appearance (88.0 vs 75.6 P = 0.008) and emotional (70.7 vs 60.5 P = 0.034) HRQL. Surprisingly, incidence of cancer, recent disease, gender and education were not associated with HRQL impairment. CONCLUSIONS Australians with keratinocyte cancer experience poorer HRQL compared to a Spanish population. Offering non-surgical means when amenable and consideration of psychosocial needs during clinical course is emphasised. While our study highlights the importance of HRQL tools, our results question the sensitivity of the SCI across populations. Further research is required to substantiate its ongoing use.
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Affiliation(s)
- Victoria L Venning
- The Skin Hospital (a branch of the Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Charlotte L Thomas
- The Skin Hospital (a branch of the Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Gayathri St George
- The Skin Hospital (a branch of the Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Fernandez-Peñas
- The Skin Hospital (a branch of the Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
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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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Lee EH, Pusic AL, Cano SJ, Klassen AF. The FACE-Q Skin Cancer Module addresses post-resection aesthetic and quality of life outcomes. Br J Dermatol 2019; 180:953-954. [PMID: 30561021 DOI: 10.1111/bjd.17525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- E H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10022, U.S.A
| | - A L Pusic
- Plastic and Reconstructive Surgery Division, Brigham and Women's Hospital, Boston, MA, U.S.A
| | - S J Cano
- Modus Outcomes, Letchworth Garden City, U.K
| | - A F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Exploring Patient Experience of Facial Nerve Palsy to Inform the Development of a PROM. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2072. [PMID: 30859034 PMCID: PMC6382227 DOI: 10.1097/gox.0000000000002072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
Background There is currently a mandate globally to incorporate patient's perceptions of their illness into outcome measures, in order to provide a deeper insight into medical practice. Facial nerve palsy (FNP) is a devastating condition that can significantly impact quality of life. However, no measure currently exists that comprehensively assesses outcome in FNP using patient perception. The aim of this study is to explore patients' experiences of FNP with the aim of informing the development of a patient-reported outcome measure. Methods Presented is a qualitative study, using in-depth semi-structured interviews with FNP patients. An interview guide was developed using expert opinion and a literature review. Interpretative description was used as the qualitative approach. Interviews were audio-recorded, transcribed, and coded line-by-line. Codes were refined using the constant comparison approach. Interviews continued until data saturation was reached. The data were used to develop a conceptual framework of patient perceived issues relating to FNP. Results The sample included 5 men and 9 women aged 57.7 years (range, 36-78) with a range of causes of FNP, including Bell's palsy (n = 5), acoustic neuroma (n = 3), trauma (n = 2), meningioma (n = 1), muscular dystrophy (n = 1), congenital (n = 1), and Ramsay Hunt syndrome (n = 1). Analysis of the 14 participant interviews led to identification of 5 major domains including "facial function concerns," "appearance concerns," "psychological function," "social function," and "experience of care." Conclusion This study provides a conceptual framework covering outcomes that matter to patients with FNP, which can be used to inform the development of a new comprehensive FNP-specific patient-reported outcome measure.
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Dobbs TD, Samarendra H, Hughes S, Hutchings HA, Whitaker IS. The FACE-Q Skin Cancer Module addresses post-resection aesthetic and quality of life outcomes: reply from authors. Br J Dermatol 2018; 180:954. [PMID: 30561004 DOI: 10.1111/bjd.17526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), 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 S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Swansea, U.K.,The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K
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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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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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Commentary on Patients' Body Image Improves After Mohs Micrographic Surgery for Nonmelanoma Head and Neck Skin Cancer. Dermatol Surg 2018; 44:1389-1390. [PMID: 30303823 DOI: 10.1097/dss.0000000000001691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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MESH Headings
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Carcinoma, Basal Cell/etiology
- Carcinoma, Basal Cell/pathology
- Carcinoma, Basal Cell/prevention & control
- Carcinoma, Basal Cell/therapy
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/prevention & control
- Carcinoma, Squamous Cell/therapy
- Female
- Humans
- Incidence
- Life Expectancy
- Male
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Quality of Life
- Radiotherapy, Adjuvant
- Risk Factors
- Skin Neoplasms/etiology
- Skin Neoplasms/pathology
- Skin Neoplasms/prevention & control
- Skin Neoplasms/therapy
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Affiliation(s)
- Kishwer S Nehal
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (K.S.N.); and Michigan Medicine, University of Michigan, Ann Arbor (C.K.B.)
| | - Christopher K Bichakjian
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (K.S.N.); and Michigan Medicine, University of Michigan, Ann Arbor (C.K.B.)
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