Facial Skin Cancer Research Articles

Patient-reported Aesthetic Satisfaction following Facial Skin Cancer Surgery Using the FACE-Q Skin Cancer Module.

Background: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.

Facial skin cancer reconstructive and cosmetic outcomes: Analysis with algorithm for its management.

Management of facial skin cancer and its complications is important research topics needing continuous update to improve the outcome. The study is to share our findings with surgeons and healthcare providers. The authors provide their efforts by pooling data from multiple institutions; as reporting surgical outcomes is significantly lacking and much needed in the Middle East and North Africa region in order to meaningfully improve quality of care. This study proposes an algorithm for management that could aid a surgical decision-making for reconstruction of defects after excision of facial skin cancer. Retrograde simple descriptive analysis study is conducted for multicenter data about management of facial skin cancer and its cosmetic outcome. The analysis involves 159 male patients and 95 females. Nonmelanoma skin cancer was reported in 250 (98.4%) of 254 cases. Reconstructive procedures were complicated in 16 cases (~6.3% of the study). Skin cancer recurrence in head and neck has happened in five cases (~1.9% of the study). Flaps used survived without major complications; however, V-Y advancement flaps showed the best aesthetic outcome. This study reports data in order to meaningfully improve the quality of care. Disease incidence, reconstructive complications, recurrences, and aesthetic outcome of facial skin cancer are included in the study. Based on the data pooling, the study proposes a simple treatment algorithm that could aid in surgical decision-making. V-Y advancement flaps showed the best aesthetic outcome.

Acute and subacute radiation toxicities of high-dose-rate brachytherapy in patients with nonmelanoma facial skin cancers

Acute and subacute radiation toxicities of high-dose-rate brachytherapy in patients with nonmelanoma facial skin cancers

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

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 < 3months 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.

Oncological and aesthetic outcome following surgical management of orbito-palpebral skin cancers: A retrospective study of 132 patients

BackgroundThe incidence of facial skin cancers continues to rise, with major studies on their impacts still lacking in the literature. This study reports on the oncological and aesthetic results following surgical management of an orbito-palpebral skin cancer. MethodsThis retrospective, monocentric study included patients treated for a non-melanoma skin cancer of the eyelid and orbit. Risk factors, location, histological type, invaded or insufficient margins, healing time, surgical management by excision and direct closure, skin graft or local flaps, self-evaluated aesthetics, and quality of life results were all compared. ResultsThe study included 132 patients operated for basal cell carcinoma (71.9%), squamous cell carcinoma (22.9%), or for another type (5.2%) between November 2011 and January 2017. Average tumor size was 9.6 ± 6.3 mm. Surgical management resulted in excision and open healing (9.1%), excision and direct closure (3.9%), skin graft (31.1%), local flap (21.9%), or another type of reconstruction (3.0%). Significant links between invaded or insufficient margins and basal cell type (OR = 3.37, p = 0.014), tumor size over 7 mm (OR = 2.7, p = 0.011), double location (OR = 8.44, p = 0.04), flap-based reconstruction (OR = 0.290, p = 0.02), and female gender (OR = 0.418, p = 0.034) were reported throughout our multivariate analysis. ConclusionsThis study brings out consequential information on factors linked with invaded or insufficient excision margins. Larger cohorts should evaluate the aesthetic outcomes in such a population.

Patient-reported adverse effects after facial skin cancer surgery: Long-term data to inform counseling and expectations

Patient-reported adverse effects after facial skin cancer surgery: Long-term data to inform counseling and expectations

Nonmelanoma Facial Skin Cancer: A Review of Diagnostic Strategies, Surgical Treatment, and Reconstructive Techniques

Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.

Patient-reported outcome measures for facial skin cancer: asystematic review and evaluation of the quality of theirmeasurement properties.

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). This systematic review identifies PROMs for facial skin cancer and appraises their methodological quality and psychometric properties using up-to-date 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. 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. 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.

Patient-Reported Outcomes and Factors Associated With Patient Satisfaction After Surgical Treatment of Facial Nonmelanoma Skin Cancer

This study measures patient-reported outcomes and identifies factors associated with patient satisfaction after excision of facial nonmelanoma skin cancer in the veteran population.

A clinical review of reconstructive techniques for patients with multiple skin cancers on the face.

Background Cases of simultaneous multiple skin cancers in a single patient have become more common. Due to the multiplicity of lesions, reconstruction in such cases is more difficult than after a single lesion is removed. This study presents a series of patients with multiple facial skin cancers, with an analysis of the surgical removal, reconstruction process, and the results observed during follow-up.Methods We reviewed 12 patients diagnosed with multiple skin cancers on the face between November 2004 and March 2016. The patients’ medical records were retrospectively reviewed to identify the type of skin cancer, the site of onset, methods of surgical removal and reconstruction, complications, and recurrence during follow-up.Results Nine patients had a single type of cancer occurring as multiple lesions, while three patients had different skin cancer types that occurred together. A total of 30 cancer sites were observed in the 12 patients. The most common cancer site was the nose. Thirteen defects were reconstructed with a flap, while 18 were reconstructed with skin grafting. The only complication was one case of recurrence of basal cell carcinoma.ConclusionMultiple skin cancers are removed by performing Mohs micrographic surgery or wide excision, resulting in multiple defect sites. The authors emphasize the importance of thoroughly evaluating local lesions surrounding the initially-identified lesions or on other sites when reconstructing a large defect which can not be covered by primary closure. Furthermore, satisfactory results can be obtained by using various methods simultaneously regarding the condition of individual patients, the defect site and size, and the surgeon’s preference.

OA132] An investigation of possible radiophysical causes of recurrence for non-melanoma facial skin cancer treated with superficial X-rays

Purpose A 2010 cohort of 177 patients with 195 non-melanoma facial skin cancer received superficial kV X-rays radiotherapy (RT) with 14 cases (7.2%) of recurrence. The cases were analyzed with respect to tumor location on the head and within the radiation field. In this study, we investigate whether the recurrences could potentially be caused by underdosage of irregular surface areas within a treatment field. Methods The pathology of the tumors was mostly (77%) basal cell carcinoma (BCC) and the remaining squamous cell carcinoma (SCC). The recurrence rate was 10 and 4 cases for BCC and PCC, respectively. The recurrences were located on the nose (5), scalp (3), cheek, forehead and ear (2 each). Within the radiation field, 42% of recurrences were located on flat surfaces receiving the prescribed dose (i.e. radioresistant) and the remaining on curved surfaces or at the edge. To estimate the dose coverage of the latter, we used the EGSnrc RZ (cylindrical symmetrical) Monte Carlo software. A nose geometry was approximated by stacked water cylinders with dimensions (radius × depth in cm): 1 × 1+1.5 × 1 + 2 × 1 + 3 × 2 and compared with a standard full scatter geometry of 3 × 5. The dose was calculated for a 4 cm circular treatment field (1 cm margin) with a mono-energetic 40 keV point source which is the approximate effective energy of 80 kVp source (used clinically) as simulated by SpekCalc. The percentage depth dose (PDD) curve along the central axis and dose profile at the surface and therapeutic depth (85% dose level about 5 mm) for the two geometries were collected and compared. Results There was no difference in PDD for the nose and standard geometry. The radial nose dose profiles, however, showed a large underdosage of 50% (surface) to 30% (therapeutic) over the 3 most lateral mm as compared to the standard geometry. Conclusions The study showed that a large portion of the recurrences were placed on curved parts or edge of the radiation fields. Monte Carlo simulations suggest that such recurrences could potentially be caused by lateral underdosage. This could partly be corrected for by adding compensating scattering material around the treatment field.

FACE-Q Skin Cancer Module for measuring patient-reported outcomes following facial skin cancer surgery.

The patient's perspective of their facial scar after skin cancer surgery influences perception of care and quality of life (QoL). Appearance satisfaction after surgery is also an important but often overlooked treatment outcome. To report the psychometric validation of the FACE-Q Skin Cancer Module consisting of five scales, measuring appearance satisfaction (Satisfaction with Facial Appearance, Appraisal of Scars), QoL (Cancer Worry, Appearance-related Psychosocial Distress) and the patient experience (Satisfaction with Information: Appearance). Participants underwent Mohs surgery for facial basal or squamous cell carcinoma or excision of early facial melanoma. Cohort 1 received a set of scales before and after surgery. Cohort 2 received the scales on two occasions in the postoperative period for test-retest reliability. Rasch measurement theory was used to select (item-reduce) the most clinically meaningful items for the scales. Reliability, validity, floor and ceiling effects and responsiveness were also analysed. Of 334 patients, 209 (response rate 62·6%) were included. Rasch analysis reduced the total scale items from 77 to 41. All items had ordered thresholds and good psychometric fit. Reliability was high (Person separation index and Cronbach's α ≥ 0·90) and scales measuring similar constructs were correlated. High floor and ceiling effects were seen for the scales. The Cancer Worry scale demonstrated responsiveness (P = 0·004). The FACE-Q Skin Cancer Module meet the requirements of the Rasch model providing linearized measurement. Discriminating between patients with minimal appearance or worry impairment may be a limitation. The scales can be used for larger validation studies, clinical practice and research.

Incidence, Recurrence and Complications after Facial Skin Cancer Excision: Retrospective Analysis of Multi-Institutional Experiences

Incidence, Recurrence and Complications after Facial Skin Cancer Excision: Retrospective Analysis of Multi-Institutional Experiences

Low-cost optical scanner and 3-dimensional printing technology to create lead shielding for radiation therapy of facial skin cancer: First clinical case series

PurposeThree-dimensional printing has been implemented at our institution to create customized treatment accessories, including lead shields used during radiation therapy for facial skin cancer. To effectively use 3-dimensional printing, the topography of the patient must first be acquired. We evaluated a low-cost, structured-light, 3-dimensional, optical scanner to assess the clinical viability of this technology. Methods and materialsFor ease of use, the scanner was mounted to a simple gantry that guided its motion and maintained an optimum distance between the scanner and the object. To characterize the spatial accuracy of the scanner, we used a geometric phantom and an anthropomorphic head phantom. The geometric phantom was machined from plastic and included hemispherical and tetrahedral protrusions that were roughly the dimensions of an average forehead and nose, respectively. Polygon meshes acquired by the optical scanner were compared with meshes generated from high-resolution computed tomography images. Most optical scans contained minor artifacts. Using an algorithm that calculated the distances between the 2 meshes, we found that most of the optical scanner measurements agreed with those from the computed tomography scanner within approximately 1 mm for the geometric phantom and approximately 2 mm for the head phantom. We used this optical scanner along with 3-dimensional printer technology to create custom lead shields for 10 patients receiving orthovoltage treatments of nonmelanoma skin cancers of the face. Patient, tumor, and treatment data were documented. ResultsLead shields created using this approach were accurate, fitting the contours of each patient's face. This process added to patient convenience and addressed potential claustrophobia and medical inability to lie supine. ConclusionsThe scanner was found to be clinically acceptable, and we suggest that the use of an optical scanner and 3-dimensional printer technology become the new standard of care to generate lead shielding for orthovoltage radiation therapy of nonmelanoma facial skin cancer.

Facial skin cancers among yemenis patients: A prospective hospital-based study

Objective: the aim is to study the facial skin cancer among Yemenis, determine the common types, common sites, the pattern of the disease, and the possible risk factors associated with it. Materials and Methods: The study is a prospective descriptive hospital-based study carried out at Al-Gomhori Teaching Hospital in Sana'a. The material consisted of Yemen patients attending the Department of Oral and Maxillofacial Surgery and who were diagnosed clinically and histopathologically with having facial skin cancer. Patients who had previous treatment (surgical, radiation, or chemotherapy) or who have recurrent cancer, or who refused to participate in the study were excluded from the study. Results: During the study period, 100 cases of facial skin cancers were seen, 66 cases (66%) were male and 34 cases (34%) were female. The male-to-female ratio was 1.9–1. The majority of patients (94%) were over the age of 40 years, and the peak incidence was the 7th decade of life. Basal cell carcinoma was the most common type accounting for 72% followed by squamous cell carcinoma 27% and malignant melanoma 1%. The infra-orbital region was the most affected site accounting (21%), followed by the naso-labial region and the nose (18%) for each, the temporal region (14%) and the check (12%). Outdoor work was the main risk factor and associated with the development of 70% of facial skin cancer. Conclusion: Facial skin cancers in Yemen still remains the disease of the elderly and deprived patients. The majority of patients (94%) were over the age of 40 years. Males were affected more than females. The male to female ratio was 1.9-1. Basal cell carcinoma was the most common type. Infera-orbital region was the most affected site, followed by the Naso-labial region. Prolonged exposure to sunlight (outdoor work) was the main risk factor that play an important role to development of facial skin cancer among Yemenis.

Facial skin cancer surgery under local anesthesia.

Rationale: In the last decade, the incidence of skin cancers has been increasing. Early diagnosis, treatment and prevention are crucial in helping to diminish the incidence, mortality and morbidity associated with skin cancers.Objective: This article presents arguments for and against local anesthesia in the treatment of skin cancers, including the clinical cases, a summary of treatment, and prognosis.Methods and results: Under local anesthesia, local and loco-regional flaps offer an optimal shape and volume for face reconstruction, minimizing the operative time and therefore the hospitalization. Facial skin cancer surgery under local anesthesia also contributes significantly to decreasing health care costs compared to general anesthesia.Discussions: Although in our practice, excision of skin tumors in the facial area under local anesthesia is a frequent and harmless surgical method, it can cause increased stress in some patients. However, the benefits are significantly greater than the disadvantages.

A Comparison of the Local Flap and Skin Graft by Location of Face in Reconstruction after Resection of Facial Skin Cancer.

BackgroundSurgery for reconstruction of defects after surgery should be performed selectively and the many points must be considered. The authors conducted this study to compare the local flap and skin graft by facial location in the reconstruction after resection of facial skin cancer.MethodsThe authors performed the study in patients that had received treatment in Department of Plastic Surgery, Gyeongsang National University. The cases were analyzed according to the reconstruction methods for the defects after surgery, sex, age, tumor site, and tumor size. Additionally, the authors compared differences of aesthetic satisfaction (out of 5 points) of patients in the local flap and skin graft by facial location after resection of facial skin cancer by dividing the face into eight areas.ResultsA total of 153 cases were confirmed. The most common facial skin cancer was basal cell carcinoma (56.8%, 87 cases), followed by squamous cell carcinoma (37.2%, 57 cases) and bowen's disease (5.8%, 9 cases). The most common reconstruction method was local flap 119 cases (77.7%), followed by skin graft 34 cases (22.3%). 86 patients answered the questionnaire and mean satisfaction of the local flap and skin graft were 4.3 and 3.5 (p=0.04), respectively, indicating that satisfaction of local flap was significantly high.ConclusionWhen comparing satisfaction of patients according to results, local flap shows excellent effects in functional and cosmetic aspects would be able to provide excellent results rather than using a skin graft with poor touch and tone compared to the surrounding normal skin.

Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer

Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer

What do patients say about facial skin cancer surgery? Analysis of aspects of quality using a new tool to measure patient reported experience and outcome in the Surgical Management of Non- Melanoma Skin Cancer of the Head and Neck (NMSC)

Introduction: Non-melanoma skin cancer (NMSC) of the head and neck is commonly treated with complete surgical excision. Patients are concerned about both outcomes of cancer treatment as well as the process of care and outcomes, including complete excision and cosmetic result. We designed a tool to measure and analyse patient experience within the process of care and their satisfaction with the cosmetic result. We seek to evaluate both patient reported outcome measures (PROM) and experience (PREM) following facial skin surgery.

Wolfe Graft: Monitoring Success

Background: A Wolfe graft is a full thickness skin graft, which in the head and neck region is commonly used to repair defects created by the excision of facial skin cancers. There is limited data analysing and quantifying the graft success rate post-operatively. It is reported that graft failure rate varies between 2% and 30%. This study identifies factors that contribute to the success of Wolfe grafts and suggests a method of quantifying their take, which can be used in the outpatient setting.