Patient-reported quality of life and aesthetic satisfaction continues to improve for 1-year after Mohs surgery: A multicenter prospective cohort study.

Summary

In a 4-center prospective cohort (N=990), patient-reported aesthetic satisfaction and quality-of-life scores improved over one year after facial Mohs surgery. Tumor location (notably nose), defect size, sex, and prior history significantly influenced outcomes, whereas reconstruction type did not.

Key Findings

• Patient-reported FACE-Q satisfaction improved across 1 year post-Mohs surgery.
• Nasal tumor location associated with lower appearance and scar satisfaction (P = .026, P < .001) and higher psychosocial distress (P = .004).
• Larger defects increased psychosocial distress (P = .037) and reduced scar appraisal (P = .008). Reconstruction type did not influence satisfaction.

Clinical Implications

Use tumor location and defect size to risk-stratify for psychosocial distress and lower scar satisfaction; counsel patients with nasal or periocular tumors accordingly. Reconstruction technique may be chosen for oncologic/functional reasons without compromising satisfaction.

Limitations

• Observational design limits causal inference
• Potential selection and residual confounding; conducted in U.S. centers only

Future Directions

Integrate PROs into shared decision-making and develop targeted psychosocial interventions for high-risk sites (nose, periocular). Validate findings internationally and assess digital tools to monitor recovery.