Elevated perioperative anxiety was found to be associated with the eyelid area compared to non-eyelid facial locations and non-facial areas (p ≤ 0.05).
Clinical Pearls
This study was a cross-sectional case series identifying the risk factors that may play a role in Mohs micrographic surgery (MMS) associated anxiety among those with non-melanoma skin cancer
Patient demographics, surgical locations, self-reported anxiety scores, and quality of life details were recorded for 100 patients undergoing MMS for non-melanoma skin cancer. Adjusted linear and logistic regression analyses were performed to identify potential risk factors that predict MMS-associated anxiety
Elevated perioperative anxiety was found to be associated with the eyelid area compared to non-eyelid facial locations and non-facial areas (p ≤ 0.05). Patients with graduate degrees were found to have decreased levels of anxiety compared those with college degrees or below (p ≤ 0.05).
Discussion:
Perioperative anxiety is an important factor for dermatologic surgeons to consider when treating patients. In the setting of MMS, there have been few studies investigating the factors associated with anxiety in the perioperative period. The aim of this study was to analyze MMS-associated anxiety among patients with nonmelanoma skin cancer and to identify risk factors that may play a role in its development.
An IRB-approved cross-sectional study was performed among 100 patients from July 2018 to January 2020. The primary outcome was self-reported anxiety measured via the Self rating Anxiety Scale (SAS). Quality of life was measured via the Dermatology Life Quality Index (DLQI). Both surveys were given to patients in clinic before the start of the procedure. Demographic history, cutaneous surgical history, and non-skin related surgical history were identified in the questionnaire. Mohs surgery locations were obtained from electronic medical record.
The authors found elevated perioperative anxiety to be associated with the eyelid area vs. non-eyelid facial locations and non-facial areas (P≤ 0.05). Furthermore, patients with graduate degrees were found to have decreased levels of anxiety compared to those with college degrees or high school education or less (P≤ 0.05). In terms of quality of life, the correlation model analysis showed high anxiety (index score >45) was correlated with poorest QoL (OR = 1.14, p = .04). However, above median anxiety failed to show correlation with QoL.
Perioperative anxiety is certainly an issue that is insufficiently investigated in the MMS literature. With dermatologic surgery on the face and particularly the eyelid causing the most anxiety relatively in this study, clinicians should keep this in mind when performing procedures in this area. In addition, being cognizant of the education level of patients and their understanding of the disease and treatment may be helpful in providing optimal patient care. Limitations of this study include the small samples size and the study design of a case series in a single academic hospital. The patients who did have MMS completed on the eyelid location were also younger on average, female, and had less experience with MMS procedures. These factors should be considered as possible confounders when interpreting these results.
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