title: A quality-of-life study in high-risk (thickness > = or 2 mm) cutaneous melanoma patients in a randomized trial of 1-cm versus 3-cm surgical excision margins.
abstract: A quality-of-life study was carried out to test the hypothesis that melanoma patients treated with a 3-cm margin of excision suffer greater impairment of their quality of life than those treated with a 1-cm margin. The secondary aim was to determine the predictors of a poor patient perception of their excision scar. A postal questionnaire study was carried out using Hospital Anxiety and Depression (HAD), Psychosocial Adjustment of Illness Scale-Self-Report (PAIS-SR), Medical Outcomes Survey-Short Form 36 (MOS-SF36), and the Cassileth Scar questionnaires. Data were collected from 426 of the 537 patients who were mailed the questionnaires (response rate 79%). Fourteen percent had clinically significant anxiety and 5% had significant depression. A poor attitude toward quality of health care was associated with youth. Patients treated with a 3-cm margin excision had significantly poorer mental and physical function 1 mo after surgery, which disappeared within 6 mo. The greater difficulties experienced by the 3-cm margin group were particularly in their domestic, sexual, and social roles. Women, younger patients, those with poor physical and mental function after surgery, and those treated by a 3-cm margin were more likely to report a poorer perception of their scar. The poorer scar perception of patients in the 3-cm group persisted throughout the study period. Use of a 3-cm margin of excision for melanoma is associated with significantly more morbidity than use of a 1-cm margin, but this effect disappears in 6 mo. Patients treated by 3-cm excision were more likely, however, to have a persistent poor view of their scar. Youth and being female were also predictors of poor perception of the scar.
authors.affiliation: Division of Genetic Epidemiology, Cancer Research UK Clinical Center, St. James's University Hospital, Beckett Street, Leeds, UK. j.newton-bishop@cancer.org.uk
authors.forename: Julia A
authors.initials: JA
authors.lastname: Newton-Bishop
authors.forename: Clarissa
authors.initials: C
authors.lastname: Nolan
authors.forename: Faye
authors.initials: F
authors.lastname: Turner
authors.forename: Margaret
authors.initials: M
authors.lastname: McCabe
authors.forename: Candida
authors.initials: C
authors.lastname: Boxer
authors.forename: J Meirion
authors.initials: JM
authors.lastname: Thomas
authors.forename: Gill
authors.initials: G
authors.lastname: Coombes
authors.forename: Roger P
authors.initials: RP
authors.lastname: A'Hern
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Barrett
mesh_terms: D000375:Aging / Q000523:psychology; D001007:Anxiety / Q000209:etiology; D001290:Attitude; D002921:Cicatrix / Q000523:psychology; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008545:Melanoma / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D008603:Mental Health; D008875:Middle Aged; D011184:Postoperative Period; D011787:Quality of Health Care; D011788:Quality of Life; D012306:Risk; D012649:Self Concept; D012727:Sex Characteristics; D012878:Skin Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D012917:Social Adjustment; D011795:Surveys and Questionnaires