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01-04-2012 | Surgery | Article

Preserved appearance ‘key to patient satisfaction’ with melanoma surgery


Free abstract

MedWire News: Patients tend to be most satisfied with the outcome of reconstructive surgery for head and neck melanoma if they feel their appearance has been relatively preserved, research shows.

This is best achieved by avoiding skin grafts and instead choosing primary closure and local tissue transfer, say John Kim (Northwestern University, Chicago, Illinois, USA) and fellow researchers writing in the Canadian Journal of Plastic Surgery.

Kim's group evaluated psychosocial, esthetic, and emotional outcomes of head and neck surgery, noting that these may be more important to patients than standard surgeon-based outcome measures.

They gave a questionnaire to 51 patients who had undergone wide local excision of 57 head and neck melanomas with immediate reconstruction. The cohort included 20 women and the mean age was 54 years.

The location of melanoma was cheek in 21 patients, auricle in 10, forehead in seven, neck in seven, scalp in five, nose in four, and eyelid in three. The method of reconstruction was primary closure in 25 patients, skin grafting in 15, local flap in 15, and free flap in two patients.

Patients were followed up for 26.9 months on average. Four patients experienced complications related to surgery and there were 13 tumor recurrences; neither outcome differed by method of reconstruction.

Forty-two patients (82.4%) completed the questionnaire, and the responses contained some interesting insights, say Kim et al.

First, the extent to which patients believed their appearance had been altered was inversely correlated with the extent to which they were satisfied with the outcome of treatment and positively correlated with the extent of their emotional impairment.

Second, the extent to which patients believed their appearance had been altered was directly correlated with their overall rating of reconstructive outcomes.

Third, patients' perceived alteration of appearance varied significantly by tumor location and size and method of reconstruction. For instance, melanomas on the eyelid and nose had worse scores (indicating greater alteration of appearance) than did tumors on other parts of the head and neck.

Also, reconstruction with full-thickness skin grafts scored significantly lower for appearance alteration than did primary closures or local tissue transfers. There was no different between primary closure and local flaps, however.

Finally, for cheek melanomas but not tumors in other locations, the tumor size was positively correlated with scores for appearance alteration.

Kim et al conclude: "The degree of emotional impairment following the reconstruction of head and neck melanoma extirpative defects correlates with the patient's perception of appearance alteration."

They advise: "Primary closure is the ideal method for reconstruction… Skin grafts, on the other hand, tend to produce unfavorable outcomes."

By Joanna Lyford

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