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Mohs Micrographic Surgery for Facial Skin Cancers: Do Patients Have Realistic Expectations?

By: Lauren Harrison, MS
Posted: Tuesday, May 26, 2020

Patients undergoing Mohs micrographic surgery for facial skin cancers seem to underestimate the size of their scar after surgery and on average believe their scar will be less than half of the length of the actual scar. Surgeons, however, accurately predicted scar length. Joseph F. Sobanko MD, of the University of Pennsylvania, Philadelphia, and colleagues published their study findings in JAMA Network Open.

“[Because] surgeons appear to accurately estimate the length of most surgical scars, [they] have an opportunity to set realistic patient expectations about scar length before surgery,” concluded the authors.

This cross-sectional study was conducted between December 2017 and February 2018 at the Mohs micrographic surgery clinic of a single health system. A total of 101 patients who underwent the surgical treatment of facial skin cancers during this time were included in this study, along with the 86 surgeons who performed the procedure. Skin cancers were located on the forehead, temples, cheeks, nose, and perioral/periorbital area. Participants were asked to independently draw the anticipated scar length on their skin prior to surgery, which were then compared with the scar length postoperatively.

Although 83.2% of patients underestimated the length of their scar, 77.9% of surgeons correctly estimated the scar length. The postoperative scar was 2.2 times longer than patients’ initial estimate, compared with 1.1 times longer than surgeons’ preoperative estimate. In addition, patients with melanoma tended to underestimate the size of their scar to a greater degree; in fact, melanoma was linked with longer postoperative scans than non-melanoma skin cancers (median 80 mm vs. 40.4 mm; P < .001). On subgroup analysis, preoperative consultation with a surgeon, a personal history of previous Mohs surgery, or patient-directed research about Mohs surgery were all not correlated with an improvement in a patient’s estimate of scar length.

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