Patient Satisfaction With Surgery of Basal Cell Carcinoma: Keep It Safe and Simple

Patient-reported outcomes are important quality indicators in dermatologic surgery.

We performed a prospective cohort study to assess patient satisfaction with surgery of basal cell carcinoma (BCC) and identify patient-, tumor-, and treatment-related influencing factors.

Patients who underwent BCC surgery at the Vivantes Skin Cancer Center in Berlin, Germany, rated global, cosmetic, and functional satisfaction on a visual analog scale from 0 (very dissatisfied) to 10 (very satisfied) at suture removal (T0) and three months after surgery (T1). Group differences were examined with the Kruskal-Wallis test and independent associations with linear regressions.

Among 150 participants (41.3% females, mean age 75.3 years), 82.7% had a BCC in the head/neck region. Reconstruction after micrographically controlled excision was performed most frequently with advancement or rotation flaps (52%), followed by linear closure (27.3%), transposition flaps (8.7%), and skin grafts (6%). Patient satisfaction was overall high (global: mean 8.5 (T0) and 8.3 (T1), cosmetic: 7.3 (T0) and 7.6 (T1), functional: 8.6 (T0) and 8.2 (T1)) and intercorrelated with physicians' satisfaction. Males and patients aged >75 years were significantly more satisfied with cosmetic and functional results. Poor health state, tumor localization on the nose, complications, pain, and prolonged wound healing were associated with lower satisfaction in most categories. Linear wound closure led to better global satisfaction than local flaps and skin grafts at T1.

Patient satisfaction was related to inherent patient- and tumor-associated factors, reconstruction technique, and complications, aspects to be discussed during shared decision-making to reconcile patients' expectations with practicability.