Patient quality of life fluctuates before and after Mohs micrographic surgery: A longitudinal assessment of the patient experience

J Am Acad Dermatol. 2018 Jun;78(6):1060-1067. doi: 10.1016/j.jaad.2018.02.065. Epub 2018 Mar 5.

Abstract

Background: Changes in patient perceptions of quality of life (QOL) after Mohs micrographic surgery (MMS) may benefit from different counseling or treatment.

Objective: To measure QOL before and after MMS and to identify risk factors associated with impaired QOL.

Methods: Prospective observational study of 727 patients with skin cancer who self-reported QOL via the Skin Cancer Index immediately before and at 1 to 2 weeks and 3 months after MMS.

Results: QOL fluctuated after MMS. At 1 to 2 weeks after surgery, overall QOL remained unchanged compared with before MMS. Patients reported reduced anxiety about skin cancer but had increased distress about social interactions and physical appearance. At 3 months after surgery, patients reported an overall improvement in QOL compared with before MMS (P = .0007). Age younger than 65 years (P = .0001), female sex (P = .0001), and tobacco use (P = .03) were associated with lower QOL scores at all assessment points.

Limitations: Single-site observational study. Significant loss to follow-up at both time points after MMS.

Conclusion: Patients with skin cancer had persistent concerns about social interactions and physical appearance 1 to 2 weeks after MMS, but all aspects of their QOL improved by 3 months after surgery. Patients who underwent MMS that were younger than 65 years, were female, or smoked were at increased risk for longitudinally impaired QOL.

Keywords: Mohs micrographic surgery; longitudinal; quality of life; satisfaction; scar; skin cancer.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Anxiety / psychology*
  • Body Image / psychology*
  • Esthetics
  • Female
  • Humans
  • Interpersonal Relations
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Mohs Surgery / methods
  • Mohs Surgery / psychology*
  • Patient Reported Outcome Measures
  • Perioperative Care
  • Prospective Studies
  • Quality of Life*
  • Skin Neoplasms / pathology
  • Skin Neoplasms / psychology
  • Skin Neoplasms / surgery*
  • Statistics, Nonparametric
  • Time Factors