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Surgeons should take psychosocial impact of scarring from skin cancer surgery into account

In a literature review, researchers addressed the psychological impacts of facial scarring following skin cancer surgery and the utility of patient-reported outcome tools in identifying patients with scar concerns preoperatively.

Using the PubMed database, the researchers identified articles related to scarring and appearance within the context of cutaneous oncology and surgical reconstruction.

Joseph F. Sobanko

The researchers found scars, particularly those located on the head and neck that change physical appearance, tended to have a negative impact on patients’ psychosocial functioning.

Findings also showed medical professionals often underestimated the importance of physical appearance for skin cancer patients.

Younger patients tended to experience higher levels of preoperative anxiety levels; however, older patients also expressed significant concern for their physical appearance, according to the researchers.

The researchers stated that patients’ degree of psychosocial distress was not associated with the objective severity or size of a scar, but rather with the patient’s own perception of scar severity.

Use of patient-reported outcome (PRO) tools to assess the potential psychosocial impact of scarring after skin cancer surgery can be particularly helpful, and PRO instruments that assess quality-of-life (QoL) changes and other psychosocial domains are becoming more frequently recognized by agencies such as the Agency for Healthcare Research and Quality for their importance.

Five validated tools currently exist for PROs with regard to nonmetastatic skin cancer: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Melanoma Module (EORTC QLQ-M), the Functional Assessment of Cancer Therapy – Melanoma (FACT-M), the Facial Skin Cancer Index (FSCI), the Skin Cancer Quality of Life Impact Tool (SCQOLIT) and the Skin Cancer Quality of Like (SCQOL).

The researchers found that addressing patients’ psychosocial concerns regarding scarring may actually improve postoperative outcomes, and that patients who had better pretreatment skin-related QoL, less comorbidity and a better overall mental health status were more likely to have better skin-related QoL and long-term satisfaction following non-melanoma skin cancer treatment.

Additionally, a referral to a mental health professional may be necessary when the psychological burden is especially high.

Surgeons may want to consider screening for psychological distress and/or impairment in QoL, body image dissatisfaction, depression and anxiety in certain groups, such as in those for whom a significant facial deformity is anticipated, according to the researchers. – by Abigail Sutton

Disclosures: Sobanko reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.