Abstract
Patients are satisfied when surgical outcomes meet their expectations. Dissatisfaction with surgical scars is one of the most common reasons that patients sue surgeons who perform Mohs micrographic surgery (MMS). To measure the accuracy of patient and physician estimations of scar length prior to skin cancer removal with MMS. This cross-sectional study was conducted between December 1, 2017, and February 28, 2018, at the MMS clinic of a single tertiary referral center health system. A total of 101 adults presenting for MMS for treatment of facial skin cancers volunteered for this study, and 86 surgeons who performed the MMS procedure participated. Patients and physicians independently drew the anticipated scar length on the patients' skin prior to surgery. Preoperative estimates by patients and surgeons were compared with actual postoperative scar length. Of the 101 patients who participated, 57 patients (56.4%) were men and 57 patients (56.4%) were aged 65 years or older. Eighty-four patients (83.2%) underestimated scar length, whereas 67 of the 86 surgeons (77.9%) correctly estimated the scar length (P < .001). The actual postoperative scar length was 2.2 (interquartile range, 1.5-3.6) times larger than the patients' preoperative estimate but only 1.1 (interquartile range, 1.0-1.2) times larger than the surgeons' preoperative estimate (P < .001). Preoperative consultation with the surgeon, a personal history of MMS, or patient-directed research about MMS were not associated with improvement of patients' estimations of scar length. This study's findings suggest that patients with facial skin cancers have unrealistic expectations regarding scars that measure, on average, less than half the length of the actual postoperative scars. Surgeons appear to accurately estimate the length of most surgical scars and have an opportunity to set realistic patient expectations about scar length before surgery.
Highlights
Mohs micrographic surgery (MMS) is touted for its high cure rate and ability to spare healthy tissue.[1]
Scars were a median of 2.2 times larger than patients expected, compared with 1.1 times larger for physicians’ estimates. Meaning These findings suggest that scars from Mohs micrographic surgery for facial skin cancers may be longer than patients expect
A prospective, observational, cross-sectional study was performed on patients older than 18 years presenting for MMS for treatment of facial skin cancers at the University of Pennsylvania between December 1, 2017, and February 28, 2018
Summary
Mohs micrographic surgery (MMS) is touted for its high cure rate and ability to spare healthy tissue.[1] Patients focused on tissue sparing may have unrealistic expectations for small scars after MMS. Patients with facial skin cancers place high importance on a normal appearance after surgery.[2,3,4] Scars following skin cancer surgery have been shown to diminish patients’ quality of life,[2,3,4] and largerthan-expected scars may increase patient distress.[5].
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