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Adverse Psychological Events Associated With Mohs Micrographic Surgery: A Rapid Review and Meta-Analysis
Karen B Schmaling1, Victoria R Sharon2, Reason Wilken2
1Department of Psychology, Washington State University, Vancouver, WA.
Background:
Anxiety and other psychological symptoms may not be addressed in Mohs micrographic surgery (MMS) informed consent procedures nor assessed during the perioperative period.
Objective:
First, to examine psychological adverse events (AEs) associated with MMS, and second, to examine psychological risks identified in MMS informed consent forms.
Materials And Methods:
This review was registered (PROSPERO CRD42024594453). First, MEDLINE and PsycINFO were searched from inception through November 5, 2024 for studies of adults undergoing MMS with quantitative measures of psychological status in the perioperative period. Thirteen measures, most often of anxiety, were standardized for pooled analysis. Second, Google was searched for US MMS consent forms on October 23, 2024. Data were extracted with 20% conducted in duplicate; authors were contacted for missing data. Risk of bias was assessed.
Results:
The literature search resulted in 29 studies totaling 6,455 patients. Using one standardized score per study, patients reported a pooled distress rating of 25.26 out of 100, with significant heterogeneity (95% confidence interval, 11.44‒61.11, I2 = 100%). The consent form search resulted in 20 consent forms: none listed psychological risks.
Conclusion:
Psychological AEs of MMS are common and should be addressed as risks in informed consent processes.
Insights
Psychological distress is common after Mohs micrographic surgery (MMS). Current informed consent forms fail to mention these psychological risks, highlighting a gap in patient care.
Area of Science:
- Dermatology
- Psychology
- Medical Ethics
Background:
- Psychological symptoms are often overlooked in Mohs micrographic surgery (MMS) informed consent and perioperative care.
- This oversight may lead to unaddressed patient distress.
Purpose of the Study:
- To investigate psychological adverse events (AEs) associated with MMS.
- To determine if psychological risks are identified in MMS informed consent forms.
Main Methods:
- A systematic review of MEDLINE and PsycINFO for studies on psychological status in perioperative MMS patients.
- Analysis of US MMS consent forms obtained via Google search.
- Standardized analysis of psychological measures, primarily anxiety.
Main Results:
- 29 studies involving 6,455 patients were analyzed.
- Patients reported a pooled distress rating of 25.26/100, with significant heterogeneity.
- None of the 20 reviewed consent forms mentioned psychological risks.
Conclusions:
- Psychological adverse events are frequent in patients undergoing MMS.
- Informed consent processes for MMS should explicitly include psychological risks.
