A Cost Comparison Between Mohs Micrographic Surgery and Conventional Excision for the Treatment of Head and Neck Melanomas In Situ and Thin Melanomas.

BACKGROUND: Variation in operative setting and surgical technique exists when treating specialty site melanomas. There are limited data comparing costs among surgical modalities. OBJECTIVE: To evaluate the costs of head and neck melanoma surgery performed with Mohs micrographic surgery or conventional excision in the operating room or office-based settings. METHODS: A retrospective cohort study was performed on patients aged 18 years and older with surgically treated head and neck melanoma in 2 cohorts, an institutional cohort and an insurance claims cohort, for the years 2008-2019. The primary outcome was total cost of care for a surgical encounter, provided in the form of insurance reimbursement data. A generalized linear model was used to adjust for covariates affecting differences between treatment groups. RESULTS: In the institutional and insurance claims cohorts, average adjusted treatment cost was highest in the conventional excision-operating room treatment group, followed by the Mohs surgery and conventional excision-office setting ( p < .001). CONCLUSION: These data demonstrate the important economic role the office-based setting has for head and neck melanoma surgery. This study allows cutaneous oncologic surgeons to better understand the costs of care involved in head and neck melanoma treatment. Cost awareness is important for shared decision-making discussions with patients.

Measuring Stakeholder Assessments of Postsurgical Facial Scars: A Retrospective Cohort Inter-rater Analysis of Patients, Physicians, and Medical Student Observers.

BACKGROUND: The relationship of postoperative facial scar assessments among patients, physicians, and societal onlookers is not clearly defined. OBJECTIVE: To identify differences in perceived scar outcomes by different stakeholders. METHODS AND MATERIALS: Retrospective cohort study at a single Mohs micrographic surgery (MMS) center during which scars were assessed by: patients, physicians, and medical student observers not involved in patients' care using the Patient and Observer Scar Assessment Scale (v.2). Eighty-one patients graded their scars at 2 visits: 1 to 2 weeks post-MMS and 3 months post-MMS. Deidentified patient photographs were taken at each visit and graded by 4 physicians and 12 observers. RESULTS: At week 1, there was a significant difference in overall opinion of scar appearance between patient and physicians (p = .001) and medical student observers and physicians (p < .001). Physicians graded scars more favorably. At 3 months, there remained a difference in scar evaluations between patient and physicians (p = .005), whereas medical student observers rated scars more similarly to physicians (p = .404). CONCLUSION: Postoperative scar perceptions differ among stakeholders. Physicians must be mindful of this disparity when counseling patients in the perioperative setting to align patient expectations with realistic scar outcomes.

Patient-Centered Care in Dermatologic Surgery: Practical Strategies to Improve the Patient Experience and Visit Satisfaction.

Patient-centered care in dermatologic surgery emphasizes addressing the preferences, values, and concerns of the surgical patient in an effort to improve the overall experience. Impediments affecting the delivery of Mohs micrographic surgical treatment of skin cancers are present throughout the perioperative period. Defining actionable strategies to improve outcomes can be challenging due to sparse literature and minimal high-quality scientific studies. This review focuses on the current evidence supporting practical recommendations in each surgical setting to improve the patient experience and increase visit satisfaction.

Skin Cancer Epidemiology and Sun Protection Behaviors Among Native Americans

Introduction: Sun protection behaviors in Native American populations are historically under-reported, though the greatest proportion lives in Western states that have the greatest UV-index burden within the United States. Materials/Methods: We deployed an anonymous questionnaire online, in-clinic, and in the community to Native Americans belonging to federally recognized tribe and have resided on a reservation. The questionnaire explored demographics, sunscreen use and preference, skin cancer screening, and personal and family history. Results: One-hundred fifty-nine respondents fit the inclusion criteria. Greater than 80% reported experiencing at least one sunburn, though only 10.7% and 36.4% reported regular sunscreen use on their body and face, respectively. The participants reported a myriad of reasons for which they do not utilize sunscreen, with 9% believing that Native Americans, or other skin of color persons, do not develop skin cancer. This was additionally observed in the low reports of ever receiving a skin exam (7.5%). Discussion: Sunscreen use among Native Americans (36.4%) appears to be greater than other skin of color users, but less than that of non-Hispanic Whites (40.4%). We postulate that this may be due to the respondents living in states with high UV burden, or an intrinsically greater propensity to burn. Native American populations tend to lack skin cancer screenings by dermatologists and understanding of skin cancer etiology. Efforts are needed to encourage education and dermatologic services to Native American reservations. J Drugs Dermatol. 2019;18(5):420-423.