The majority of outcomes data following dermatologic surgery are limited to physician-reported adverse effects in the short-term postoperative period. However, symptoms may persist for some patients, which can influence their perception about healing. Our goal was to characterize long-term patient-reported symptoms following facial skin cancer surgery.
A cross-sectional study was performed of patients ≥21 years old who underwent facial skin cancer surgery between March 1, 2016 and March 31, 2018. The FACE-Q Skin Cancer Adverse Effects Checklist1,2 was administered, which addressed postoperative symptoms of pain, discomfort, sensitivity, numbness, tingling, tightness, itchiness, swelling, bruising, and difficulty with facial movements. Frequencies were calculated as the number of patients who reported a symptom during the specified time-point; any response other than “not at all” was counted as report of the corresponding symptom. Electronic medical records were reviewed to collect treatment information. Patient and surgical characteristics were evaluated using descriptive statistics.
Three hundred ninety-six of 1049 eligible patients completed the questionnaire (response rate 37.8%). Responses were categorized based on time between surgery date and survey completion: <6 months (average 15.7 ± 8.0 weeks), 6 months to <1 year (average 38.0 ± 8.3 weeks), and ≥1 year (average 84.7 ± 23.1 weeks). Patient demographics, tumor type, tumor location, and repair type are shown in Table 1. The average age of survey responders was 65.6 ± 11.9 years; 51.0% (n=202) were men, and 49.0% (n=194) were women. The average age of survey non-responders was 65.1 ± 13.8 years; 55.2% (n=360) were men, and 44.8% (n=293) were women. Demographic characteristics of responders were similar to non-responders. Overall, frequency of postoperative symptoms was low (range 2.3–43.4%) (Figure 1). The frequency of sensitivity, numbness, and tightness was highest <6 months and ≥1 year following surgery. Amongst repair types, flap or graft repair was associated with the highest frequency of symptoms ≥1 year following surgery, particularly numbness, tingling, tightness, and itchiness. Amongst anatomic surgical sites, lip location was associated with highest frequency of symptoms ≥1 year following surgery, particularly numbness, tingling and difficulty with facial movements.
Table 1.
Characteristics of study patients (n=396), by postoperative time period
| <6 months | 6 months to <1 year | ≥ 1 year | |
|---|---|---|---|
| Demographic Factors | n (%) | n (%) | n (%) |
| Male | 38 (46.9) | 47 (48.0) | 125 (58.1) |
| Female | 43 (53.1) | 51 (52.0) | 90 (41.9) |
| Caucasian race | 79 (97.5) | 92 (93.9) | 207 (96.3) |
| Age, years (mean ± SD) | 67.0 ± 10.5 | 66.3 ± 12.1 | 64.9 ± 12.3 |
| Skin Cancer Type | |||
| Basal cell carcinoma | 50 (61.7) | 66 (67.3) | 126 (58.6) |
| Squamous cell carcinoma | 12 (14.8) | 15 (15.3) | 45 (20.9) |
| Invasive melanoma | 2 (2.5) | 4 (4.1) | 16 (7.4) |
| Melanoma in situ | 16 (19.8) | 11 (11.2) | 23 (10.7) |
| Other | 1 (1.2) | 2 (2.0) | 5 (2.3) |
| Wound Healing Type | |||
| Second intention | 9 (11.1) | 8 (8.2) | 17 (7.9) |
| Primary closure | 39 (48.1) | 54 (55.1) | 116 (54.0) |
| Flap | 18 (22.2) | 26 (26.5) | 63 (29.3) |
| Graft | 15 (18.5) | 10 (10.2) | 19 (8.8) |
| Anatomic Location of Surgery | |||
| Forehead/eyebrow | 11 (13.6) | 16 (16.3) | 31 (14.4) |
| Temple | 7 (8.6) | 8 (8.2) | 19 (8.8) |
| Eyelid | 3 (3.7) | 6 (6.1) | 11 (5.1) |
| Cheek | 21 (25.9) | 32 (32.7) | 57 (26.5) |
| Nose | 25 (30.9) | 22 (22.4) | 57 (26.5) |
| Lip/Chin | 5 (6.2) | 10 (10.2) | 22 (10.2) |
| Ear | 9 (11.1) | 4 (4.1) | 18 (8.4) |
Figure 1.
Patient reported frequencies (%) of adverse events <6 months, 6 months to <1 year, and ≥1 year following surgery
Although postoperative complications occur in <1% of cases of cutaneous oncologic surgery3, patient experience a range of symptoms following surgery. While patients often experience pain in the short-term postoperative period,4 milder symptoms such as numbness, sensitivity, and tightness are more common in the long-term; the face is the most pressure-sensitive area of the body5 which may contribute to these findings. Patients who underwent graft or flap repair reported the most symptoms, similar to previous studies.4 Those who underwent surgery on the lip reported more long-term symptoms, and may experience a greater quality of life impact (i.e. eating, speaking, and social interaction) following surgery compared to other locations.
Limitations include a primarily Caucasian study population, cross-sectional design, and the possibility of response-bias. Longitudinal studies including a larger, more diverse population may better characterize symptoms over time. Nonetheless, this patient-reported data may help physicians counsel patients regarding the potential for long-term postoperative symptoms and help patients manage expectations accordingly.
Funding/support:
This research was funded, in part, by NIH/NCI Cancer Center Support Grant P30 CA008748.
Footnotes
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Conflict of Interest/Financial Disclosure: This research was funded, in part, by NIH/NCI Cancer Center Support Grant P30 CA008748. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication. The FACE-Q Skin Cancer Module is owned by Memorial Sloan-Kettering Cancer Center.
References
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