Author: Jeremy Seth Honaker

Publisher:

Published: 2017

Total Pages: 145

ISBN-13:

The purpose of the study is to evaluate the temporal development of symptom onset and severity and to determine relationships between delayed wound healing (wound total surface area), symptoms (depressive symptoms [DS], pain, sleep disturbance [SD]), and health related quality of life (HRQoL) in older adults undergoing Mohs micrographic surgery [MMS] of lower extremity non melanoma skin cancer (NMSC) healing by secondary intention. This is a prospective exploratory study of patients undergoing MMS for NMSC in a single academic dermatological surgery clinic. Subjects were enrolled on the day of surgery and followed weekly for 4 weeks, except 4 subjects were followed weekly until healed. Descriptive statistics and T-tests were used to explore differences between those with and without wound expansion at week 1 among these variables: demographics, co-morbidities, laboratory values, and NIH PROMIS DS, pain, SD, and HRQoL surveys. Logistic regression was performed between the variables and the wound expansion group to determine predictors of wound healing. An analysis revealed that subjects undergoing MMS for NMSC generally have good HRQoL, and symptom measures and HRQoL consistently improve by week 4 postoperatively. There was no significant relationships noted between demographics, co-morbidities, laboratory values, symptom measures, HRQoL, and wound total surface area. A trend was noted with the 14 subjects with 5 experiencing wound expansion greater than -15% expansion and 9 were without expansion at week 1. No significant differences were noted between demographics, co-morbidities, laboratory values, symptom measures, or health related quality of life with those with and without wound expansion, except for age. Age was significantly different with the wound expansion group averaging 12 years older (p = 0.02). Of the 4 subjects followed until healed, 2 subject's wounds expanded and required 10-12 weeks to heal compared to 6-8 weeks in 2 subjects without wound expansion. Logistic regression revealed a trending toward significance (p=.08) with age. The likelihood for experiencing wound expansion increases by 24% for every increase in year (OR = 1.24 CI 95% 0.97-1.58). In conclusion, this preliminary report reveals that older adults may be more likely to have wound expansion, which may result in delayed wound healing.