Beyond Aesthetics: The Impact of Facial Non-Melanoma Skin Cancer (NMSC) Surgery on Patient Quality of Life

Author(s): Celine Lund-Nielsen Remvig, Nicolai Midtgaard Blom, Claes Hannibal Kiilerich, Frederik Penzien Wainer Mamsen, Hannah Trøstrup Pedersen

Facial non-melanoma skin cancer (NMSC) is the most common skin malignancy and often requires excision with reconstruction. Oncological outcomes are favorable, but effects on aesthetics and psychosocial wellbeing are less defined. We examined whether reconstructive technique influences patient-reported outcomes one year after facial NMSC surgery. Methods: In a prospective cohort at Zealand University Hospital, Denmark, patients underwent facial excision closed by either direct suturing (DS) or flap surgery (FS). Outcomes were measured with the FACE-Q Skin Cancer module: satisfaction with appearance, scar perception, cancerrelated anxiety, and quality of life. Results: Of 225 enrolled patients, 52 (23.1%) completed one-year follow-up (DS n=38; FS n=14). Mean scar satisfaction scores were 91/100 for DS and 71/100 for FS. Cancer-related anxiety was higher after FS versus DS (23 vs 14/100; p=0.005). Overall satisfaction with facial appearance did not differ significantly. Stratification suggested outcomes depended more on anatomical site than technique. A modest inverse correlation was observed between scar satisfaction and cancer worry (r=−0.34). Conclusions: Reconstructive technique influenced patient-reported outcomes, with FS associated with lower scar satisfaction and greater cancer-related anxiety. Site effects were prominent: nasal defects—often requiring flaps—had the lowest satisfaction, whereas cheek and forehead procedures showed high satisfaction irrespective of closure method.