Patient experiences and outcomes following facial skin cancer surgery: A qualitative study

Lee, Erica H.; Klassen, Anne F.; Lawson, Jessica L.; Cano, Stefan; Scott, Amie; Pusic, Andrea L.

doi:10.1111/ajd.12323

Cited by 76 publications

(80 citation statements)

References 17 publications

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“…Most studies focused on HNC or facial cancer surgery; however, some studies looked at multiple cancers (Speraw, 2009), skin cancer (Lee et al, 2016), and lymphoedema (McGarvey et al, 2014). Most studies focused on HNC or facial cancer surgery; however, some studies looked at multiple cancers (Speraw, 2009), skin cancer (Lee et al, 2016), and lymphoedema (McGarvey et al, 2014).…”

Section: Resultsmentioning

confidence: 99%

“…Survival is paramount A recurring theme in many studies (Costa et al, 2014;Furness, Garrud, Faulder, & Swift, 2006;Henry et al, 2014;Konradsen, Kirkevold, & Zoffmann, 2009;Turpin, Dallos, Owen, & Thomas, 2009;Lee et al, 2016;Nayak, Pai, & George, 2016;Van Doorne et al, 1994) was the importance placed on survival, and large changes to facial appearance were accepted in the context of having survived the disease, and as such were perceived as a necessary 'trade-off' or price that needed to be paid for continued life:…”

Section: Resultsmentioning

confidence: 99%

“…Facial appearance was also inextricably bound up with practical problems (Lee et al, 2016), such as functional difficulties with eating or speaking, the need to clean the site, and sometimes the use of prostheses. The need to engage in healthy behaviours, for example reducing sun exposure, became a practical consideration.…”

Section: Resultsmentioning

confidence: 99%

“…During the diagnosis and treatment period, the way in which the care team dealt with the changed facial appearance was important (Henry et al, 2014;Konradsen et al, 2009;Lee et al, 2016;Speraw, 2009 Participants' descriptions suggest a balance is needed between acknowledging appearance changes without stigmatizing. Konradsen et al (2009) found that appearance was minimized by the care team, meaning that the participant's negative feelings about their appearance were silenced as they learned that altered appearance, whilst an important issue to them, was not something that was of importance to staff.…”

Section: The Care Teammentioning

confidence: 99%

“…Many studies identified social avoidance as a coping strategy (Costa et al, 2014;Henry et al, 2014;Konradsen et al, 2012;McGarvey et al, 2014). This could lead to increased social isolation and perpetuated feelings of rejection: 'I will stay at home; I hate being the centre of attention ' (Konradsen et al, 2012) Participants described how using concealment and camouflage helped them to appear and feel more 'normal', thereby reducing negative reactions (Costa et al, 2014;Henry et al, 2014;Lee et al, 2016;McGarvey et al, 2014;Turpin et al, 2009). This could lead to increased social isolation and perpetuated feelings of rejection: 'I will stay at home; I hate being the centre of attention ' (Konradsen et al, 2012) Participants described how using concealment and camouflage helped them to appear and feel more 'normal', thereby reducing negative reactions (Costa et al, 2014;Henry et al, 2014;Lee et al, 2016;McGarvey et al, 2014;Turpin et al, 2009).…”

Section: Coping Strategiesmentioning

confidence: 99%

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Cancer and changes in facial appearance: A meta‐ethnography of qualitative studies

Thompson

Sewards

Baker

2020

British J Health Psychol

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Introduction. Living with an altered facial appearance as a result of treatment for cancer requires considerable psychological adjustment. As such it is essential that health care professionals understand the lived experience of people affected. This systematic review provides a meta-ethnography of studies that have explored the experience of changed facial appearance as a result of cancer. Methods.A search of four databases (Web of Science, CINAHL, PsycInfo, and Scopus) took place using terms relating to qualitative research, cancer, and changed facial appearance. Thirteen studies were identified, appraised, and included in the synthesis. The findings and interpretations within the studies were subject to meta-ethnography procedures so as to elicit novel cross-cutting themes.Findings. The experience of changed facial appearance after cancer was clustered into three contexts. In the context of the disease, subthemes were the primacy of survival, the changing relationship with the disease, and the impact of the care team on the experience of changed appearance. In the context of the social world, subthemes were positive reactions, negative reactions, and coping strategies. In the context of the self, subthemes were the self under attack, self-to-self relating, the self in the world, and rebuilding the self.Conclusions. The findings indicate that health care professionals must conduct holistic assessments, so as to fully recognize and where necessary address the impact upon self. The meta-ethnography shows that the experience of facial appearance change following cancer is complex and requires awareness of a number of theoretical areas including identity construction, social support, stigmatization, and the specific literature on visible difference. Statement of contributionWhat is already known on this subject?Changed facial appearance after cancer can cause significant social difficulties and impact on the sense of self.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: The Care Teammentioning

confidence: 99%

Section: Coping Strategiesmentioning

confidence: 99%

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Cancer and changes in facial appearance: A meta‐ethnography of qualitative studies

Thompson

Sewards

Baker

2020

British J Health Psychol

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Optimizing Outcomes for Cutaneous Head and Neck Melanoma

2017

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In this issue, Moyer and colleagues 1 report long-term follow-up of a large cohort of patients with head and neck melanoma treated with a "square" staged excision technique using permanent sections for comprehensive margin assessment. The median follow-up of 9.3 years demonstrated excellent long-term disease control of 834 lesions with projected local recurrence rate of 2.2% at 10 years. The mean margin required for histologic clearance of tumor was 9.3 mm for melanoma in situ and 13.7 mm for invasive melanoma. The authors demonstrated that lesion size, presence of invasion, and prior incomplete excision were associated with larger surgical margins required for histologic clearance.Melanoma of the lentigo maligna subtype accounted for nearly 75% of the head and neck melanomas in this series. This is a critical point because melanomas developing in an area of chronic photodamage in the head and neck region present many challenges. Lentigo maligna has had a long, confusing history. It was initially called Hutchinson's melanotic freckle in the 1800s and felt to be an infectious process. Lentigo maligna is still misconstrued by some as a premalignant lesion. It is now well-recognized as a subtype of melanoma in situ. Once invasion is present, melanoma staging 2 and prognosis are directly related to tumor thickness, similar to other melanomas, with potential for metastasis and death, and should be treated according to current melanoma standards. 3 Following these guidelines, patients in this study underwent sentinel lymph node biopsy if indicated.It is now well-established, in the dermatologic literature, that standard surgical margins for excision of melanomas on the trunk and extremities are frequently inadequate when applied to melanomas of the head and neck region. This study further supports this finding, because only 25% of melanoma in situ lesions were cleared with a 0.5-cm margin, and only 25% of invasive melanomas were cleared with a 1-cm margin. The National Comprehensive Cancer Network clinical practice guidelines clearly state that for melanomas of the "lentigo maligna type, greater than 0.5 cm may be necessary to achieve histologically negative margins," and that "exhaustive histologic assessment of margins should be considered." 3 The surgical treatment of melanoma of the lentigo maligna type has therefore evolved from standard wide excision to staged techniques that allow enhanced margin evaluation and reduce local recurrence. However, there remains debate in the field of dermatologic surgery over the ideal method of margin examination for these challenging melanomas, ranging from per-

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Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology

Dey

Ishii

Boahene

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCEObjectively measuring how Mohs defect reconstruction changes casual observer attention has important implications for patients and facial plastic surgeons. OBJECTIVE To use eye-tracking technology to objectively measure the ability of Mohs facial defect reconstruction to normalize facial attention. DESIGN, SETTING, AND PARTICIPANTSThis observational outcomes study was conducted at an academic tertiary referral center from January to June 2016. An eye-tracking system was used to record how 82 casual observers directed attention to photographs of 32 patients with Mohs facial defects of varying sizes and locations before and after reconstruction as well as 16 control faces with no facial defects. Statistical analysis was performed from November 2018 to January 2019. MAIN OUTCOMES AND MEASURESFirst, the attentional distraction caused by facial defects was quantified in milliseconds of gaze time using eye tracking. Second, the eye-tracking data were analyzed using mixed-effects linear regression to assess the association of facial defect reconstruction with normalized facial attention. RESULTSThe 82 casual observers (63 women and 19 men; mean [SD] age, 34 [12] years) viewed control faces in a similar and consistent fashion, with most attention (65%; 95% CI, 62%-69%) directed at the central triangle, which includes the eyes, nose, and mouth. The eyes were the most visually important feature, capturing a mean of 60% (95% CI, 57%-64%) of fixation time within the central triangle and 39% (95% CI, 36%-43%) of total observer attention. The presence of Mohs defects was associated with statistically significant alterations in this pattern of normal facial attention. The larger the defect and the more centrally a defect was located, the more attentional distraction was observed, as measured by increased attention on the defect and decreased attention on the eyes, ranging from 729 (95% CI, 526-931) milliseconds for small peripheral defects to 3693 (95% CI, 3490-3896) milliseconds for large central defects. Reconstructive surgery was associated with improved gaze deviations for all faces and with normalized attention directed to the eyes for all faces except for those with large central defects.CONCLUSIONS AND RELEVANCE Mohs defects are associated with altered facial perception, diverting attention from valuable features such as the eyes. Reconstructive surgery was associated with normalized attentional distraction for many patients with cutaneous Mohs defects. These data are important to patients who want to know how reconstructive surgery could change the way people look at their face. The data also point to the possibility of outcomes prediction based on facial defect size and location before reconstruction. Eye tracking is a valuable research tool for outcomes assessment that lays the foundation for understanding how reconstructive surgery may change perception and normalize facial deformity.

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Patient experiences and outcomes following facial skin cancer surgery: A qualitative study

Cited by 76 publications

References 17 publications

Cancer and changes in facial appearance: A meta‐ethnography of qualitative studies

Cancer and changes in facial appearance: A meta‐ethnography of qualitative studies

Optimizing Outcomes for Cutaneous Head and Neck Melanoma

Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology

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