The Psychological Impact of Facial Skin Cancer

Introduction and Aims: Patients presenting with low risk cutaneous malignancies are rarely offered formal support or counselling. Nonetheless 80% of non-melanoma skin cancers occur in the head and neck rendering the tumour and surgical scarring clearly visible. This study was designed to quantify the social and emotional impact of facial skin malignancies before and after surgery irrespective of tumour severity.

Materials and Methods: Fifty three patients with facial skin malignancies were prospectively evaluated before and three months after surgery using the Skin Cancer Index (SCI). This validated, disease-specific assessment tool measures three distinct subscales: emotion, social and appearance. Higher scores reflect improvement in quality of life (QOL).

Results: Excision led to a significant increase in SCI (p<0.001). Patients with squamous cell carcinomas reported significantly greater improvements than those with basal cell carcinomas (p=0.016). Women had lower pre and post-operative scores, but greater improvement in the emotional and appearance subscales, while men showed greater improvement in the social sub-scale. Increasing age correlated with greater improvement in QOL following surgery.

Conclusion: Lower pre-operative SCI scores confirm the presence of anxiety among patients with cutaneous facial malignancies. Surgical excision improves social, emotional and cosmetic wellbeing, particularly in patients with squamous cell carcinomas. Female and younger patients appear most vulnerable to QOL anxieties pre-operatively.