Objective-To establish the clinical responsiveness of the Skin Cancer Index (SCI), a new diseasespecific quality of life (QOL) instrument, and to assess demographic and clinical factors which impact QOL in patients with nonmelanoma skin cancer (NMSC).Study Design-Prospective study of 183 patients with NMSC of the face and neck referred to a tertiary care Mohs surgery clinic.Methods-The SCI is a 15 item, validated, disease-specific QOL instrument with 3 distinct subscales, Emotion, Social, and Appearance. Higher scores reflect better QOL. The SCI and the Dermatology Life Quality Index (DLQI), a general dermatology instrument, was administered at initial consultation and 4 months after surgical treatment. Multivariate analysis was conducted to assess demographic and clinical factors predictive of QOL for both instruments.Results-The SCI total score and all three subscale scores increased with treatment, demonstrating strong evidence of responsiveness over time (P < .001) in contrast with the DLQI (P = .46). Predictors of poorer QOL for the SCI included female sex and cancers located on the lip. Patients who demonstrated greatest improvement in QOL with treatment included those who were younger (< 50 yr) and had lower reported household income. Also, first time NMSC patients and those patients who underwent less extensive reconstructions demonstrated greater improvements in QOL.Conclusion-The SCI is a sensitive and responsive QOL instrument for patients with NMSC. Distinct demographic and clinical variables that impact QOL have been demonstrated using this multidimensional, disease-specific instrument.

To validate a disease-specific quality-of-life instrument-the Skin Cancer Index-intended to measure quality-of-life issues relevant to patients with nonmelanoma skin cancer. Methods: Internal reliability, convergent and divergent validity with existing scales, and factor analyses were performed in a cross-sectional study of 211 patients presenting with cervicofacial nonmelanoma skin cancer to a dermatologic surgery clinic. Results: Factor analyses of the Skin Cancer Index confirmed a multidimensional scale with 3 distinct subscales-emotional, social, and appearance. Excellent internal validity of the 3 subscales was demonstrated. Substantial evidence was observed for convergent validity with the Dermatology Life Quality Index, Rosenberg Self-Esteem Scale, Lerman's Cancer Worry Scale, and Medical Outcomes Survey Short-Form 12 domains for vitality, emotion, social function, and mental health. Conclusions: These findings validate a new diseasespecific quality-of-life instrument for patients with cervicofacial nonmelanoma skin cancer. Studies on the responsiveness of the Skin Cancer Index to clinical intervention are currently under way.

General dermatology QOL instruments demonstrated minimal handicap at initial diagnosis and little change after treatment of NMSC. Although the associations were modest, improvement in some aspects of well-being after treatment of NMSC was demonstrated. A more disease-specific instrument may be necessary to study this disease process further.

Sun-protective behaviors were positively associated with certain QOL subscale scores in the population in the study. General QOL instruments demonstrated minimal impact of nonmelanoma skin cancer on patients at initial diagnosis. However, general measures may not be sensitive to the impact of nonmelanoma skin cancer. The development of a more disease-specific instrument may be necessary to evaluate this disease process.

To determine whether change occurred in the general quality of life (QOL) of nonmelanoma skin cancer (NMSC) patients following surgery, to identify variables associated with patients' change in QOL, and to assess the impact of the disease and treatment on sunprotective behaviors and cigarette smoking. Design: Longitudinal prospective study of 121 consecutive patients referred to a dermatologic Mohs surgery clinic with NMSC of the head and neck. Interventions: Quality-of-life, smoking habit, and sunprotective behavior assessments were performed before treatment (N = 121) and after surgical treatment at 1 (n = 105) and 4 (n = 101) months. Quality-of-life measures included the Medical Outcomes Study 36-Item Short-Form Health Survey and the Functional Assessment of Cancer Therapy-General. Results: Overall, general QOL measures demonstrated little change over time. Only the mental (Medical Outcomes Study 36-Item Short-Form Health Survey) and emotional (Functional Assessment of Cancer Therapy-General) domains of QOL showed statistically significant change over time. A 2-way interaction showing effects for age and time on emotional well-being was modified by a 3-way interaction that depended on employment status. Emotional well-being scores for younger employed NMSC patients increased over time compared with scores among younger unemployed patients. In addition, many patients adopted greater use of sun-protective behaviors at 4 months following surgery. No change in cigarette smoking status was evidenced. Conclusions: Use of sun-protective behaviors increases after treatment. General QOL instruments demonstrate little change following treatment of NMSC. Although the associations are modest, improvements in emotional and mental health well-being following treatment of NMSC were demonstrated, especially for those younger than 65 years and employed. A disease-specific instrument may be necessary to further study this disease process.