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Brief Report
January 2019

Association of Quality of Life With Surgical Excision of Early-Stage Melanoma of the Head and Neck

Author Affiliations
  • 1Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
  • 2State University of New York Downstate College of Medicine, Brooklyn, New York
JAMA Dermatol. 2019;155(1):85-89. doi:10.1001/jamadermatol.2018.3409
Key Points

Question  What is the association between surgical excision of Tis and T1a melanomas of the head and neck and the health-related quality of life of a patient?

Findings  In this longitudinal cohort study involving 56 patients with a Tis or T1a melanoma of the head and neck, patient-reported health-related quality of life was worse in the perioperative period but improved to above baseline levels by 6 months and 1 year after excision of the tumor. Women and those younger than 65 years experienced worse health-related quality of life over the treatment course.

Meaning  Surgical excision of Tis and T1a melanomas of the head and neck may be associated with long-term net improvement of health-related quality of life; baseline or preoperative counseling may be tailored to groups at risk of lower health-related quality of life.

Abstract

Importance  Surgical excision is the standard-of-care treatment for Tis and T1a melanomas of the head and neck. Currently, however, the association of diagnosis and surgical treatment of these typically slowly progressive and nonfatal melanomas with a patient’s health-related quality of life (HRQoL) is unknown.

Objective  To characterize and assess HRQoL in patients with Tis and T1a head and neck melanoma, evaluate changes in HRQoL over the surgical treatment course, and identify patient characteristics associated with lower HRQoL.

Design, Setting, and Participants  This longitudinal, prospective cohort study involved patients with Tis or T1a melanoma of the head and neck who underwent staged excision at a single tertiary care center (Memorial Sloan Kettering Cancer Center, New York, New York) and were recruited from June 1, 2016, to February 28, 2017. Patients were followed up for 1 year after their surgical procedure. Participants were asked to complete 2 patient-reported outcome measure questionnaires, Skindex-16 and Skin Cancer Index (SCI), at 4 time points: baseline, perioperative (1 to 2 weeks after surgery), and 6-month and 1-year follow-up.

Main Outcomes and Measures  Scores on the Skindex-16 and SCI questionnaires.

Results  In total, 56 patients were included in the study, among whom 24 (43%) were female and 32 (57%) were male, with a mean (range) age of 67.2 (32-88) years; all patients self-identified as white. Forty-one (73%) questionnaires at perioperative, 49 (88%) at 6-month postoperative, and 41 (73%) at 1-year postoperative time points were completed. At baseline, female patients and those younger than 65 years had statistically significantly worse HRQoL on the Skindex-16 questionnaire (mean score, 14.2 [95% CI, 9.1-21.9] and 16.1 [95% CI, 9.8-26.4]) and on the SCI questionnaire (mean score, 57.2 [95% CI, 48.3-67.6] and 53.2 [95% CI, 44.1-64.3]) compared with males (mean Skindex-16 score, 7.0 [95% CI, 4.8-10.3]; mean SCI score, 73.5 [95% CI, 66.0-81.7]) and those aged 65 years or older (mean Skindex-16 score 7.1 [95% CI, 5.0-10.0]; mean SCI score, 74.3 [95% CI, 67.7-81.6]). Questions that demonstrated the worst scores at baseline were worry about skin condition (Skindex-16) and worry about future skin cancers (SCI). The emotions subscale scores on the Skindex-16 questionnaire showed the greatest improvement from baseline to 1-year follow-up levels (26.6 vs 15.3; P < .001) and so did the appearance subscale scores on the SCI questionnaire (64.0 vs 84.6; P < .001). The score difference in HRQoL by sex diminished over time, whereas the score difference by age persisted through the first year.

Conclusions and Relevance  Improvement in HRQoL at the 6-month and 1-year follow-up was associated with surgical excision in patients with early-stage head and neck melanoma, and younger and female patients experienced worse HRQoL. These results may be used in tailoring counseling for this patient population.

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