Appearance-related psychosocial distress following facial skin cancer surgery using the FACE-Q Skin Cancer

Arch Dermatol Res. 2019 Nov;311(9):691-696. doi: 10.1007/s00403-019-01957-2. Epub 2019 Jul 23.


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.

Keywords: FACE-Q Skin Cancer; Patient-reported outcomes; Psychosocial distress; Skin cancer surgery.

MeSH terms

  • Age Factors
  • Aged
  • Cicatrix / etiology
  • Cicatrix / psychology*
  • Consciousness
  • Cross-Sectional Studies
  • Dermatologic Surgical Procedures / adverse effects*
  • Face / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Physical Appearance, Body
  • Psychometrics
  • Quality of Life
  • Severity of Illness Index
  • Skin Neoplasms / psychology
  • Skin Neoplasms / surgery*
  • Stress, Psychological / diagnosis
  • Stress, Psychological / epidemiology*
  • Stress, Psychological / etiology
  • Surveys and Questionnaires / statistics & numerical data
  • Time Factors