Skin Cancer Index Research Articles

Quality of Life in Patients Affected by Facial Basal Cell Carcinoma: Prospective Longitudinal Pilot Study and Validation of Skin Cancer Index in Lithuanian Language.

Facial basal cell carcinoma (BCC) poses significant challenges due to its potential for local destruction and impact on quality of life (QoL). Continuous research is necessary to identify novel factors influencing the quality of life within this demographic across diverse cultural settings. The aims of this study were to translate, culturally adapt, and validate the Lithuanian version of Skin Cancer Index, subsequently utilizing this questionnaire in the pilot phase of the study to achieve the following: (1) identify the differences in short- and long-term QoL, (2) establish empirical correlations between SCI scores and aesthetic facial regions, evaluate the potential differences between age, gender, and tumor size groups. A prospective longitudinal study was conducted with 100 consecutive patients. The SCI was translated into Lithuanian language, with a rigorous assessment of its psychometric properties to confirm validity. Alongside hypothesis testing, a detailed analysis of variables was conducted. Statistical techniques, including t-tests and ANOVA, were employed to compare scores across demographic and clinical groups, with effect size calculations for further interpretation. Our findings demonstrate that the Lithuanian SCI successfully fulfills the criteria established by the COSMIN checklist. Surgical treatment for facial BCC notably enhances QoL, particularly evident six months post-surgery. Analysis of SCI scores identified demographic and clinical factors associated with lower QoL, including female gender, treatment with skin plasty, and tumor sites in aesthetically sensitive areas like the cheek, nose, and eyelid. The Lithuanian version of the SCI is a reliable and valid tool for assessing QoL in facial BCC patients. Our findings underscore the global relevance of understanding the multifactorial influences on QoL in BCC patients. Early diagnosis, less invasive treatment approaches, and tailored post-operative care are crucial in minimizing the psychological, social, and appearance-related burdens of facial BCC.

Quality of Life in Cervicofacial Nonmelanoma Skin Cancer: Assessment with the Skin Cancer Index

Quality of Life in Cervicofacial Nonmelanoma Skin Cancer: Assessment with the Skin Cancer Index

A hyperspectral index-based approach for in vivo automatic detection of skin tumors from hyperspectral images

Skin cancer is the most common human malignancy and early diagnosis is important for successful treatment. Hyperspectral imaging provides both spectral and spatial information which may be useful for tumor diagnosis. In the present study, hyperspectral images of 36 skin tumors (seborrheic keratosis, actinic keratosis, basal cell carcinoma, squamous cell carcinoma) were acquired and analyzed. A skin cancer index was defined taking into account the differences in the angles made by the spectral slopes of the tumors and normal skin and the x axis in the spectral range (580-600) nm (where the differences in spectral signatures proved to be significant). When compared to histopathological diagnosis, the index allowed for differentiation between benign and malignant tumors and even between seborrheic and actinic keratosis or basal cell carcinoma and squamous cell carcinoma. Benign tumors had an index under 0.39999, while basal cell carcinoma ranged between 0.4000-0.59999, and squamous cell carcinoma between 0.6000-06999. In conclusion, the hyperspectral image-based skin tumor index is an objective method of identification and differentiation of skin tumors and may become a useful tool in their early diagnosis

Quality of Life Before and After Radiation Therapy for Early-Stage Keratinocyte Carcinoma: A Longitudinal Analysis

Little is known about patient-reported quality of life (QOL) before and after radiotherapy (RT) for early keratinocyte carcinoma (KC). The present study tested the hypothesis that QOL is hypothesized to deteriorate soon after RT, with subsequent improvement of a magnitude similar to other KC treatments. This observational study assessed prospectively collected longitudinal patient-reported QOL data at a single center. Patients undergoing external beam RT for early-stage (T0-2, <4 cm) KC that completed the Skindex-16 (S16) or Skin Cancer Index (SCI) before and at least once after RT were included. These indices include subscales of symptoms, emotions, and functioning for S16 and emotional, social, and appearance for SCI. 81 patients (median age 79 years) were treated for early KC, most being basal cell carcinomas (87%) on the face (80%) an average of 1.3 cm in diameter. Composite S16 scores and total SCI scores showed significant, clinically meaningful improvements at 3 months and 6 weeks after RT, respectively. QOL declined at 6 weeks after treatment on the S16 symptoms subscale. Concurrently, S16 and SCI emotional subscales significantly improved, and this trend persisted for 2+ years. Improvements in S16 functioning and SCI social and appearance QOL occurred after RT. The magnitude of improvement in QOL 3-12 months after RT was comparable to what has been previously reported after other types of KC treatments, like surgery. QOL related to symptoms deteriorates during the first 6 weeks after RT for early KC, but it improves by 3 months. QOL related to emotions, functioning, social, and appearance all improve after RT. These changes in QOL are similar to those observed after other treatments of early KC.

Quality of Life Before and after Radiotherapy for Early-Stage Keratinocyte Carcinoma: A Longitudinal Analysis

Cutaneous squamous and basal cell carcinoma (keratinocyte carcinoma, KC) are common malignancies treated with radiotherapy (RT) to preserve form and function. Treatment of KC can compromise quality of life (QOL), but little is known about patient-reported QOL before and after RT for early KC. The purpose of this study was to assess prospectively collected patient-reported QOL before and after RT for early KC and compare this to previously reported studies of other treatments. It was hypothesized that QOL deteriorates soon after RT, with subsequent improvement of a magnitude similar to previously published reports of other KC treatments. Patients undergoing RT for early-stage (T0-2, <4 cm) KC who completed a QOL assessment before and at least once after RT were the subjects of study. Characteristics of patients, tumors and treatment were recorded. Patient-reported QOL was measured by 2 validated indices: Skindex-16 (S16, including subscales of symptoms, emotions, functioning; lower score is better QOL) and Skin Cancer Index (SCI, including emotional, social and appearance subscales; higher score is better QOL). Paired t-tests compared scores before and at 4 time points after treatment (6 weeks, 3 months, 1 and 2+ years), with a ≥10-point difference considered clinically significant, and a p<0.0125 considered statistically significant due to Bonferroni correction. A total of 85 patients (median age 79 years) with early KC, most of which were basal cell carcinomas (87%) on the face (80%) and an average of 1.3 cm in diameter were treated with a median of 48 Gy in 12 fractions. Composite S16 scores and total SCI scores showed significant, clinically meaningful improvements 3 months (15.2→5.2) and 6 weeks (72.0→85.7) after RT. Non-significant declines in QOL happened 6 weeks after treatment on the S16 symptom subscale (11.3→16.6). Concurrently, S16 and SCI emotional subscales (25.9→14.4 and 67.2→79.3) significantly improved, and this trend persisted for 2+ years. Improvements in S16 functioning (8.7→2.8) and SCI social (80.2→89.6) and appearance (68.6→90.5) QOL occurred. S16 demonstrated that 1-2 years after treatment, composite QOL improved by 45%, 47%, 39% and 10% in patients treated with RT, Mohs surgery, excision and electrodessication and curettage, respectively. SCI demonstrated that 3-4 months after treatment, total QOL improved by 24% and 4-13% after RT and Mohs surgery, respectively. QOL related to symptoms deteriorates at 6 weeks after RT, with clinically and statistically significant improvement seen by 3 months after RT. QOL related to emotions, functioning, social and appearance domains all improve after RT. The changes in QOL are similar if not greater than those observed after other treatments of early KC, and may help guide patient expectations following RT.

Cross-cultural adaptation of the Skin Cancer Index into Brazilian Portuguese for patients with cervicofacial nonmelanoma skin cancer

PurposeThis study aimed to translate the Skin Cancer Index (SCI) into Portuguese, adapt it for Brazilian culture, and clinically validate it.MethodsA five-stage cross-cultural adaptation model was followed, with subsequent clinical validation. Inter-rater agreement was assessed using the content validity index (CVI). The hypothesis of the non-inferiority of the CVI at 80% probability level was evaluated using an exact binomial test. We used Spearman’s rank-order and Pearson’s product–moment correlation analysis, internal consistency using McDonald’s ω and Cronbach’s α metric, and construct validity using confirmatory factor analysis. The factorial model was validated using the chi-squared test, root mean square error of approximation (RMSEA), comparative fit index (CFI), and standardized root mean square residual (SRMR).ResultsThe first stage yielded two independent translations. After synthesis, back-translation, and review, the prefinal version was tested on 40 patients. Inter-rater agreement indices on content validity were significantly higher than 80% (p < 0.05). The SCI remained stable, and the Spearman’s rank-order (rs), Pearson product–moment (r), and intraclass correlation coefficients were > 0.9, indicating excellent reliability. The reliability of McDonald’s ω was considered ideal (> 0.8) in all subdimensions and scale. Cronbach’s α was considered ideal in the “Emotional” and “Social” subdimensions and scale. Construct validity was observed in all subdimensions and scale through the criteria (χ2) p value > 0.05, RMSEA < 0.08, CFI ≥ 0.9, and SRMR ≤ 0.08.ConclusionThe cross-cultural adaptation of the SCI to Portuguese for Brazilian culture showed content validity and reliability, contributing to quality of life assessment in patients with NMSC.

A Multicenter Prospective Trial of Electronic Skin Surface Brachytherapy for Keratinocyte Carcinoma: Early Cosmesis, Quality of Life, and Adverse Events

Keratinocyte carcinomas are amenable to many treatments, including radiation therapy (RT). Electronic skin surface brachytherapy (ESSB) enables the precise delivery of radiation without radioisotopes. In this prospective multicenter clinical trial, we characterized early outcomes of ESSB prospectively through both patient- and clinician-reported measures. To corroborate the cosmesis observations, we also assessed patient-reported quality of life (QoL) and adverse events. Patients ≥60 years old with stage T1N0M0 keratinocyte carcinoma were treated with ESSB. At 2-, 6-, and 12-weeks post-treatment, cosmesis from ESSB was assessed by both the patient and a clinician study investigator as either "good," "fair," or "bad." The Skindex-16 and the Skin Cancer Index (SCI) were used to assess patient QoL before and after treatment. Adverse events were assessed using the Common Toxicity Criteria for Adverse Events, version 4.0. Cosmesis and QoL were collected at 97% (99/102) of possible patient follow-up times. By 12 weeks post-treatment, 93.9% (31/33) of patient-reported and 96.9% (31/32) of clinician-reported cosmesis outcomes were "good." Compared with baseline, total Skindex-16 score significantly deteriorated at 2 weeks post-treatment (10.5 vs 24.5, P <.001), but significantly improved at 6 weeks (10.5 vs 4.7, P=.014) and 12 weeks (10.5 vs 2.1, P=.001) post-treatment. The total SCI score significantly improved from baseline to 6 weeks (78.4 vs 89.0, P=.001) post-treatment. The most frequent adverse events were radiation dermatitis, skin pain, and pruritus. All adverse events resolved to Grade ≤1 by 12 weeks post-treatment. This prospective, multicenter study demonstrated that ESSB is associated with a high rate of "good" early patient-reported cosmesis and increasing QoL and satisfaction with time. Validated assessments demonstrated a significant improvement in quality of life and resolution of moderate early adverse events by 6 to 12 weeks after treatment and corroborate the observation of favorable cosmesis.

Testing some psychometric properties of the Italian version of the Skin Cancer Index: A questionnaire for measuring quality of life in patients with non-melanoma skin cancer.

Non-melanoma skin cancers (NMSC) include two main types: basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). Generic Health-Related Quality of Life (HRQoL) instruments revealed little to no HRQoL impairment in NMSC patients. Instead, the use of specific skin disease HRQoL tools contradicted those observations. For example, the Skin Cancer Index (SCI) was suggested as a validated instrument for the evaluation of the impact of skin cancers on HRQoL, and has already been validated in several languages, but not in Italian. The aim of this study is to testing some psychometric properties of the Italian version of the SCI questionnaire in a large sample of NMSC patients. This is a cross-sectional, single-center, observational study. Firstly, different factor models proposed in the literature were compared and the model with the best fit was identified. Secondly, the psychometric properties of the SCI, convergent validity and reliability, were evaluated. The sample was composed of 371 NMSC patients. The factor analysis revealed that a revised version of the original model had the best fit [χ2(df = 85) = 354.53, p < 0.001, RMSEA = 0.09, CFI = 0.98, TLI = 0.97, SRMR = 0.03]. The SCI had satisfactory internal consistency for all subscales (Emotional subscale: ordinal alpha = 0.95; Social subscale: ordinal alpha = 0.94; Appearance subscale: ordinal alpha = 0.94). The convergent validity with Skindex-17 psychosocial subscale was adequate for all the SCI subscales (Emotional Subscale: rho = -0.50; Social Subscale: rho = -0.54; Appearance subscale: rho = -0.44; Total Skin Cancer Index: rho = -0.56; and p < 0.001). The tested psychometric properties of the Italian version of the SCI may suggest that it is an appropriate tool to measure the HRQoL in NMSC patients, however, further studies are needed in order to confirm and tested other psychometric features of this tool.

A Multicenter Prospective Trial of Electronic Skin Surface Brachytherapy (ESSB) for Cutaneous Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC): Cosmesis, Quality of Life (QoL) and Adverse Events (AEs)

<h3>Purpose/Objective(s)</h3> SCC and BCC are amenable to a variety of treatments. ESSB has emerged as a novel option which enables precise delivery of radiotherapy (RT), potentially limiting side effects. In a prospective multicenter clinical trial, we characterized early outcomes of ESSB, hypothesizing that it affords cosmesis superior to what has been previously reported. <h3>Materials/Methods</h3> Patients ≥60 years old with clinical stage T1N0M0 SCC or BCC were recruited. Patient and clinician-reported cosmesis was evaluated with a previously reported subjective 3 tier system. QoL was assessed by the Skindex-16 (S16) and Skin Cancer Index (SCI). Assessments were performed before treatment and 2, 6 and 12 weeks post-treatment. AEs were assessed using CTCAE v4.0. A primary endpoint was patient-reported cosmesis, with the hypothesis that ESSB would be associated with a 12 week post-treatment patient-report of "good" cosmesis in ≥90% of patients. A sample size of 34 patients was calculated to determine if the rate of "good" cosmesis was superior to a previously reported 73% rate of "good" cosmesis with a type I error rate of 0.07 and a type II error rate of 0.12. Comparisons of QoL before and post-treatment were done using Wilcoxon signed rank tests. <h3>Results</h3> 34 patients were treated with ESSB prescribing 42 Gy in 6 fractions twice or thrice a week to a depth of 3 mm below skin surface. Patients were mostly women (59%); all were white and non-Hispanic. Most were treated for BCC (94%), on the face (97%) and nose (68%). Cosmesis and QoL was collected at 99 of 102 (97%) possible patient-time points. Patient and clinician-reported "good" cosmesis 12 weeks post-treatment was reported in 93% and 97% of cases, respectively. Significant decreases in QoL were noted 2 weeks post-treatment in the symptom and function subscales of the S16, but thereafter significant increases in QoL were noted in almost all subscales of S16 and SCI (see Table). The most severe AEs were grade 3 and occurred in week 3 of treatment (skin pain, 6%) and 2 weeks post-treatment (dermatitis, 42%). All AEs resolved to grade ≤1 by 12 weeks post-treatment. <h3>Conclusion</h3> This prospective study with very complete data collection supports the hypothesis that ESSB is associated with a superior rate of early patient-reported cosmesis compared to previously reported forms of RT for skin cancer. Validated assessments demonstrated a significant improvement in QoL and resolution of moderate early AEs by 6-12 weeks post-treatment and corroborate the observation of favorable cosmesis.

782 Mohs Micrographic Surgery and Patient Satisfaction in Skin Cancer; a Systematic Review

Abstract Aim Mohs micrographic surgery (MMS) has revolutionised the treatment of skin cancer. It is commonly considered as gold standard, with good cosmesis effect for patients. Patient perception plays an important outcome in skin cancers. This systematic review aims to explore evidence of post-operative patient reported satisfaction after MMS. Method We conducted a systematic search using 10 databases including OVID Medline(R), Pubmed, Cochrane (CENTRAL) of all study types between 2000–2021. Studies were appraised for bias and data was tabulated with a narrative synthesis. Results The literature search generated 1068 studies. After removing duplicates, 728 were screened and 37 underwent full-text review. Thirteen relevant studies comprising 3046 patients undergoing MMS were included. Patients undergoing MMS expressed higher anxiety pre-operatively compared to conventional excision surgery but post-operatively Mohs was associated with a significantly higher skin cancer index (SCI) score. This was both in the short- and long-term follow up. Patients showed overall very high satisfaction with the technical quality, irrespective of reconstructive complexity or the surgeon's expertise. Patients’ main concerns post-operatively included scar skin thickness, colour, and irregularity. Higher satisfaction was observed in those with better pre-operative quality of life (QOL) including skin quality, co-morbidities, mental health, and age. Conclusion Overall patient satisfaction after MMS is high and supports transition to this surgical technique within skin cancer surgery. Higher satisfaction rates are observed in patients with better pre-operative QOL. Post-operatively patients are most concerned of scar thickness, colour, and irregularity. These factors should guide surgeons’ decision-making when aiming to maximise patient satisfaction.

Construct validity of the anglicised FACE-Q skin cancer module

The FACE-Q Skin Cancer module is a patient-reported outcome measure (PROM) for facial skin cancer. It has been anglicised for the UK population and undergone psychometric testing using classical test theory. In this study, further evaluation of construct validity using Rasch measurement theory and hypothesis testing was performed. Patients were prospectively recruited to the Patient-Reported Outcome Measures In Skin Cancer Reconstruction (PROMISCR) study and asked to complete the anglicised FACE-Q Skin Cancer module. The scalability and unidimensionality of the data were assessed with a Mokken analysis prior to Rasch analysis. Response thresholds, targeting, fit statistics, local dependency, and internal consistency were examined for all items and subscales. Four a priori hypotheses were tested to evaluate the convergent and divergent validity. We additionally hypothesised that the median 'cancer worry' score would be lower in post-operative than pre-operative patients. 239 patients self-completed the questionnaire between August 2017 and May 2019. Of the ten subscales assessed, five showed relative fit to the Rasch model. Unidimensionality was present for all five subscales, with most demonstrating ordered item thresholds and appropriate fit statistics. Two items in the 'cancer worry' subscale had either disordered or very close response thresholds. Subscales of the FACE-Q Skin Cancer module demonstrated convergent and divergent validity with relevant Skin Cancer Index comparators (p<0.001). Median 'cancer worry' was lower in post-operative patients (44vs 39, p<0.001). The anglicised FACE-Q Skin Cancer module shows psychometric validity through hypothesis testing, and both classical and modern test theory.

Correction to: Comparison of the Skin Cancer Quality of Life Impact Tool and the Skin Cancer Index Questionnaire in Measurement of Health-Related Quality of Life and the Effect of Patient Education Brochures in Patients with Actinic Keratosis, Non-melanoma Skin Cancer, and Cutaneous Melanoma

Few studies have evaluated patient-reported outcome measures and the effect of patient educational materials in German patients with skin cancer. We conducted a prospective study to measure the impact of treatment on health-related quality of life in German patients with skin cancer, identify variables that may contribute to changes in health-related quality of life, and evaluate the effect of providing additional information through a patient education brochure. A total of 461 patients diagnosed with actinic keratosis, nonmetastatic nonmelanoma skin cancer, melanoma in situ, or nonmetastatic cutaneous melanoma treated between August 2018 and July 2020 were included. Ninety-seven patients were randomly selected to receive an additional patient education brochure (“Hautkrebs”). The patients completed a Skin Cancer Quality of Life Index Tool (n = 324) or a Skin Cancer Index Questionnaire (n = 137) 1 week after surgical treatment. Ninety-seven patients were provided an additional patient education brochure. We found statistical correlation between sociodemographic factors (young age and female gender) and the location of the skin cancer (head and face) and impairment of health-related quality of life in patients with skin cancer (p < 0.05). Moreover, we found that patients who were presented a brochure showed significantly higher awareness concerning direct sun exposure (p < 0.05). Impaired health-related quality of life is correlated with a patient with skin cancer’s age, gender, and the location of the lesion. Physicians should consider these factors in clinical practice and advocate the use of patient education brochures as effective assets in preventing the reoccurrence of skin cancer.

Comparison of the Skin Cancer Quality of Life Impact Tool and the Skin Cancer Index Questionnaire in Measurement of Health-Related Quality of Life and the Effect of Patient Education Brochures in Patients with Actinic Keratosis, Non-melanoma Skin Cancer, and Cutaneous Melanoma.

IntroductionFew studies have evaluated patient-reported outcome measures and the effect of patient educational materials in German patients with skin cancer. We conducted a prospective study to measure the impact of treatment on health-related quality of life in German patients with skin cancer, identify variables that may contribute to changes in health-related quality of life, and evaluate the effect of providing additional information through a patient education brochure.MethodsA total of 461 patients diagnosed with actinic keratosis, nonmetastatic nonmelanoma skin cancer, melanoma in situ, or nonmetastatic cutaneous melanoma treated between August 2018 and July 2020 were included. Ninety-seven patients were randomly selected to receive an additional patient education brochure (“Hautkrebs”). The patients completed a Skin Cancer Quality of Life Index Tool (n = 324) or a Skin Cancer Index Questionnaire (n = 137) 1 week after surgical treatment.ResultsNinety-seven patients were provided an additional patient education brochure. We found statistical correlation between sociodemographic factors (young age and female gender) and the location of the skin cancer (head and face) and impairment of health-related quality of life in patients with skin cancer (p < 0.05). Moreover, we found that patients who were presented a brochure showed significantly higher awareness concerning direct sun exposure (p < 0.05).ConclusionImpaired health-related quality of life is correlated with a patient with skin cancer’s age, gender, and the location of the lesion. Physicians should consider these factors in clinical practice and advocate the use of patient education brochures as effective assets in preventing the reoccurrence of skin cancer.

Factors related to the evolution of quality of life in patients with cervicofacial non-melanoma skin cancer.

Non-melanoma skin cancer (NMSC) is the most frequent neoplasm today, worldwide. This type of tumour presents low mortality but causes a major psychosocial impact on the patient. Studies have shown that the patient's quality of life (as detected by questionnaire scores in this respect) improves as the care process advances. The main aim of the present study is to identify the factors that are related to this favourable evolution. This descriptive cross-sectional study included patients with cervicofacial NMSC, confirmed by skin biopsy. The patients were asked to complete the Skin Cancer Index questionnaire at the time of diagnosis and subsequently at 1 week, 1 month and 6 months after treatment. Relevant demographic variables were recorded, together with information on health status and the treatment received. A total of 229 patients with biopsy-confirmed cervicofacial NMSC were included in the study population, and 220 completed the quality of life questionnaires at the necessary time points during the care process. Some variables-sex, education, marital status, history of anxiety or depression, tumour type, the treatment received and the VAS score in this respect-were found to have a statistically significant influence on the degree of improvement recorded in the quality of life questionnaire scores during follow-up. The quality of life questionnaire scores of patients with cervicofacial NMSC improve following treatment, but this progression is not homogeneous among patients. We identify the variables that are related to a greater degree of improvement on the questionnaire scales (overall, emotional and social-aesthetic).

Skin cancer in women of color: Epidemiology, pathogenesis and clinical manifestations.

Malignant melanoma and nonmelanoma skin cancers (NMSC), which include basal cell carcinoma and squamous cell carcinoma, account for 40% of all neoplasms in white patients, making these cancers the most common malignancy in the United States. Given the large number of NMSC cases in white patients, there is a correspondingly large body of literature addressing various aspects of epidemiology, pathogenesis, and treatment. The incidence of both malignant melanoma and NMSC is well established and remains significantly lower in patients with skin of color (SoC) when compared with white patients. Although there is a lower incidence of skin cancer in SoC, there is often a poorer prognosis among this group. There is even more limited data focusing on women of color, making an accurate determination of incidence and mortality difficult. This gender disparity causes decreased skin cancer awareness and index of suspicion among patients and providers, hindering appropriate evaluation and care. Therefore, there is a need for an increased understanding of skin cancer in women of color. In the traditional sense, SoC refers to people of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds. Patients in these ethnic groups have richly pigmented skin that is usually categorized as Fitzpatrick types III through VI and thus have notable differences in skin disease and presentation compared with fair-skinned individuals. We present this review of skin cancer in women of color to give a reasonably comprehensive representation of the literature to advance our understanding and knowledge in this unique population.

The Patient-Reported Outcome Measures In Skin Cancer Reconstruction (PROMISCR) study: Anglicisation and initial validation of the FACE-Q Skin Cancer Module in a UK cohort

Facial skin cancer is common, and its treatment affects patient's health-related quality of life (HRQoL), as demonstrated by patient-reported outcome measures (PROMs). In this study, we anglicise and validate the novel FACE-Q Skin Cancer Module for the UK population. Anglicisation of the FACE-Q Skin Cancer Module followed international guidance for cross-cultural adaptation. Cognitive interviews were performed, producing a reconciled and harmonised version for validation. Patients undergoing facial skin cancer excision were prospectively recruited and asked to complete the anglicised FACE-Q Skin Cancer Module, along with the Skin Cancer Index (SCI) and European Quality of Life-Five Dimensions (ED-5D) questionnaire, pre-operatively and 6-8 weeks post-operatively. Data were analysed using classical test theory. Ethical approval was obtained (REC: 16/WM/0445). One hundred and ten patients were recruited between August 2017 and July 2018. Internal consistency was high (Cronbach's alpha 0.867-0.967). All subscales had a single-factor solution using principal component analysis. Construct validity, as measured between the FACE-Q subscales and SCI subscales, was good, with >75% of a priori predictions confirmed. Pearson's r for item-total correlation was >0.80 for several items, and significant ceiling effects are shown in 7 of the 10 subscales, suggesting some item redundancy. The UK version of this well-designed PROM demonstrates good face and construct validity. There is however a degree of redundancy within the scales, and further work using Rasch analysis on a larger sample will help address this.

Dermatological Disease in Australian Heart and Lung Transplant Recipients

Background: Research examining skin disease in heart and lung transplant recipients in Australia is limited. This study aims to determine the spectrum of skin diseases encountered in Australian heart and lung transplant recipients, their effect on quality of life, and potential risk factors for skin cancer. Methods: Ninety-four participants were recruited from an Australian heart and lung transplant centre between March and December 2016. The participants were asked to fill out a questionnaire which included the Dermatology Life Quality Index and were examined for malignant and non-malignant skin disease. The association of study variables with the presence of skin cancer and Dermatology Life Quality Index score were examined using logistic regression analysis. Results: A dermatological diagnosis was made in 82 patients (87%). Actinic keratosis was the most common diagnosis, affecting 50 participants (53%), followed by skin cancer (41; 44%) and warts (14; 15%). Other non-malignant skin diseases were less common. Risk factors associated with skin cancer on multivariate modelling included age at transplantation and a history of ≥5 post-transplant skin cancers. Skin disease had a negative effect on the quality of life of a minority of patients. Conclusion: Actinic keratosis and skin cancer are very frequent in Australian heart and lung transplant recipients and more common than non-malignant skin diseases. Routine dermatological surveillance at regular intervals is advised.

Psychosocial distress in patients with cutaneous melanoma: validation of the Skin Cancer Index (SCI).

The aim of this study is to examine the factor structure and psychometric properties of the Skin Cancer Index (SCI) in a sample of patients with melanoma. This study uses data from an observational study with longitudinal follow-up examining predictors of skin self-examination in melanoma patients from Montréal, Canada. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factor structure of the 15-item SCI scale. Correlations with other psychosocial measures of anxiety and depression, fear of cancer recurrence, quality of life, and emotional well-being were computed to examine construct validity. EFA results with 241 participants revealed a two-factor structure with acceptable fit and no significant cross-loadings. CFA results with a subsample of 173 participants examining the two-factor structure and second-order structure found equivalent fit for the two solutions. Cronbach's alpha for the total scale score and both subscales was high. Both factors showed positive associations with measures of anxiety and depression and fear of cancer and negative associations with quality of life and emotional well-being. Our study suggests that the SCI functions as a reliable two-factor scale assessing emotional and social distress in patients with melanoma, with the total SCI score assessing overall psychosocial distress.

Quality of Life During Treatment for Cervicofacial Non-melanoma Skin Cancer.

Non-melanoma skin cancer (NMSC), despite its low mortality, can impose a significant psychological burden on patients. The aim of the present study is to examine the evolution of the quality of life (QOL) in patients with cervicofacial NMSC during treatment. This prospective cohort study was conducted to a group of patients with cervicofacial NMSC, confirmed by skin biopsy. These patients completed the Skin Cancer Index questionnaire at the time of diagnosis and at 1week, 1month and 6months after treatment began. Data for these patients' demographic characteristics and variables related to the type of tumour, the treatment received and the evolution of the condition were recorded. The study group was composed of 220 patients. At the time of diagnosis, the overall mean score for QOL was 54.1 (SD 21.9); for the social appearance component, it was 76.7 (SD 26.2), and for the emotional component, it was 23 (SD 25.1). Six months after treatment began, the overall mean score was 61 (SD19.1), that for social appearance, 85 (SD 20.6), and that for the emotional component, 27.4 (SD 26.6). All the differences were statistically significant (p < 0.05). The results obtained show that during the treatment period, it is at the time of diagnosis when patients with cervicofacial NMSC undergo the greatest deterioration in their QOL. In comparison with the findings obtained in previous studies, our population obtained lower overall scores in the questionnaires and less improvement during follow-up.

Validation of the English Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) Questionnaire.

Keratinocyte carcinomas (KC) impact patient quality of life (QoL). There is a need for validated QoL instruments specific to KC. The Basal and Squamous Cell Carcinoma QoL (BaSQoL) questionnaire was developed to comprehensively measure issues of importance to patients with KC. To validate and characterize the BaSQoL questionnaire for QoL measurement after diagnosis and treatment of KC. This was a prospective, observational study. Patients with basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) were asked to fill out BaSQoL, Skin Cancer Index (SCI), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Descriptive statistics and classical test theory were used to assess validity. One hundred eighty-seven subjects enrolled in this study: 122 with BCC and 65 with SCC. One hundred seventy-one subjects (91.4%) completed questionnaires at all 3 time points; 16 patients (8.6%) were lost to follow-up. Overall performance using classical test theory was good, with good internal consistency (Cronbach's α 0.63-0.80). BaSQoL subscales were strongly correlated with subscales of the SCI, demonstrating convergent validity, and weakly correlated with HADS, showing divergent validity. The English language version of BaSQoL has good face, content, and construct validity. This study validates BaSQoL for use in English-speaking patients with BCC and SCC.