Patient quality of life fluctuates before and after Mohs micrographic surgery: A longitudinal assessment of the patient experience

Background: Changes in patient perceptions of quality of life (QOL) after Mohs micrographic surgery (MMS) may benefit from different counseling or treatment. Objective: To measure QOL before and after MMS and to identify risk factors associated with impaired QOL. Methods: Prospective observational study of 727 patients with skin cancer who self-reported QOL via the Skin Cancer Index immediately before and at 1 to 2 weeks and 3 months after MMS. Results: QOL fluctuated after MMS. At 1 to 2 weeks after surgery, overall QOL remained unchanged compared with before MMS. Patients reported reduced anxiety about skin cancer but had increased distress about social interactions and physical appearance. At 3 months after surgery, patients reported an overall improvement in QOL compared with before MMS (P=.0007). Age younger than 65 years (P=.0001), female sex (P=.0001), and tobacco use (P=.03) were associated with lower QOL scores at all assessment points. Limitations: Single-site observational study. Significant loss to follow-up at both time points after MMS. Conclusion: Patients with skin cancer had persistent concerns about social interactions and physical appearance 1 to 2 weeks after MMS, but all aspects of their QOL improved by 3 months after surgery. Patients who underwent MMS that were younger than 65 years, were female, or smoked were at increased risk for longitudinally impaired QOL.