Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel

Barazzetti, Daniel Ongaratto; Barazzetti, Pedro Henrique Ongaratto; Cavalheiro, Bárbara Thomé; Ely, Jorge Bins; Nunes, Daniel Holthausen; Stamm, Ana Maria Nunes de Faria

doi:10.1590/abd1806-4841.20197842

person Daniel Ongaratto Barazzetti

schoolDepartment of Plastic Surgery, Universidade Federal de Santa Catarina (SC), Brazil.

0000-0002-5922-3386

person Pedro Henrique Ongaratto Barazzetti

schoolMedical student, Universidade Federal de Pelotas, Pelotas (RS), Brazil.

0000-0001-6255-5210

person Bárbara Thomé Cavalheiro

schoolDepartment of Anesthesiology, Universidade Federal de Santa Catarina (SC), Brazil.

0000-0003-4097-8153

person Jorge Bins Ely

schoolDepartment of Operating Technique and Experimental Surgery, Universidade Federal de Santa Catarina (SC), Brazil.

0000-0002-8226-0062

person Daniel Holthausen Nunes

schoolDepartment of Dermatology, Universidade Federal de Santa Catarina (SC), Brazil.

0000-0001-5863-555X

person Ana Maria Nunes de Faria Stamm

schoolDepartment of Clinical Medicine, Universidade Federal de Santa Catarina (SC), Brazil.

0000-0001-5186-1247

Mailing Address: Daniel Ongaratto Barazzetti. E-mail:
danielbarazzetti@hotmail.com

Conflict of interest: None.

AUTHORS’CONTRIBUTIONS

Daniel Ongaratto Barazzetti

0000-0002-5922-3386

Statistical analysis; Approval of the final version of the manuscript; Study conception and planning; Elaboration and drafting of the manuscript; Obtaining, analyzing, and interpreting the data; Effective participation in research orientation; Intellectual participation in the propaedeutic and/or therapeutic conduct of the cases; Critical review of the literature; Critical review of the manuscript

Pedro Henrique Ongaratto Barazzetti

0000-0001-6255-5210

Statistical analysis; Elaboration and drafting of the manuscript; Conception and planning of the study

Bárbara Thomé Cavalheiro

0000-0003-4097-8153

Approval of the final version of the manuscript; Critical review of the literature; Elaboration and drafting of the manuscript; Critical review of the manuscript

Jorge Bins Ely

0000-0002-8226-0062

Statistical analysis; Approval of the final version of the manuscript; Conception and planning of the study; Elaboration and drafting of the manuscript; Effective participation in research orientation; Intellectual participation in the propaedeutic and/or therapeutic conduct of the cases; Critical review of the literature; Critical review of the manuscript

Daniel Holthausen Nunes

0000-0001-5863-555X

Statistical analysis; Approval of the final version of the manuscript; Conception and planning of the study; Elaboration and drafting of the manuscript; Obtaining, analyzing, and interpreting the data; Effective participation in research orientation; Intellectual participation in the propaedeutic and/or therapeutic conduct of the cases; Critical review of the literature; Critical review of the manuscript

Ana Maria Nunes de Faria Stamm

0000-0001-5186-1247

Statistical analysis; Approval of the final version of the manuscript; Conception and planning of the study; Obtaining, analyzing, and interpreting the data; Effective participation in research orientation; Intellectual participation in the propaedeutic and/or therapeutic conduct of the cases; Critical review of the literature; Critical review of the manuscript

Questions	Domains	Possible answers
1. Over the last week, how itchy, sore, painful, or stinging has your skin been? 2. Over the last week, how embarrassed or self-conscious have you been because of your skin?	Symptoms and feelings	3 - Very much 2 - A lot 1 - A little 0 - Not at all
3. Over the last week, how much has your skin interfered with you going shopping or looking after your home or garden? 4. Over the last week, how much has your skin influenced the clothes you wear?	Daily activities	3 - Very much 2 - A lot 1 - A little 0 - Not at all
5. Over the last week, how much has your skin affected any social or leisure activities? 6. Over the last week, how much has your skin made it difficult for you to do any sport?	Leisure	3 - Very much 2 - A lot 1 - A little 0 - Not at all
7. Over the last week, has your skin prevented you from working or studying? "No", over the last week how much has your skin been a problem at work or studying?	Work and school	3 - Very much 2 - A lot 1 - A little 0 - Not at all
8. Over the last week, how much has your skin created problems with your partner or any of your close friends or relatives? 9. Over the last week, how much has your skin caused any sexual difficulties?	Personal relations	3 - Very much 2 - A lot 1 - A little 0 - Not at all
10. Over the last week, how much of a problem has the treatment for your skin been, for example, by making your home messy, or by taking up time?	Treatment	3 - Very much 2 - A lot 1 - A little 0 - Not at all

Variables	Values
Age (years)£	67.1 ± 16.0
Male gender	31(67.4%)
Profession
Outdoor work	41(89.1%)
Indoor work	5(10.9%)
Skin phototype (Fitzpatrick)
II	27(58.7%)
III	16(34.8%)
IV	3(6.5%)
Schooling
Incomplete primary	36(78.3%)
Complete primary or more	10(21.7%)
Family income
Up to two times the minimum wage	38(82.6%)
>2 and <6 times the minimum wage	8(16.4%)
Personal history of skin cancer	23(50.0%)
Family history of skin cancer	20(43.4%)
Malignant lesions
Single	23(50%)
Multiple	23(50%)

Location
Head and neck		24(52.2%)
Upper limbs		12(26.1%)
Trunk		3(6.5%)
Histological subtypes
In situ		27(58.7%)
Invasive		19(41.3%)
Differentiation by anatomical pathology
Poorly differentiated		3(6.5%)
Moderately differentiated		13(28.3%)
Well-differentiated		8(17.4%)
Layers invaded by lesion - Assessed by anatomical pathology
Hypodermis		7(15.2%)
Papillary dermis		4(8.7%)
Reticular dermis		7(15.2%)
Positive deep margins		3(6.5%)
Positive peripheral margins		1(2.2%)
Surgery performed
Primary suture		18(39.1%)
Graft		13(28.3%)
Flap		10(21.7%)
Second intention		5(10.9%)
Duration of procedure (minutes) *		32(10-120)
Data presented in absolute numbers (percentage);
*Median (minimum-maximum)

Score
Number	Question	0	1	2	3	Not relevant	Not completed
1	Itching stinging/pain	10	23	9	4	-	0
2	Embarrassment/self-consciousness	25	14	6	1	-	0
3	Effect on household work	15	17	11	3	0	0
4	Effect on clothing	15	20	7	4	0	0
5	Effect on planning leisure time	16	17	8	3	2	0
6	Effect on sports	29	15	1	1	0	0
7*	Effect on work	-	18	5	-	23	0
	If "no" to question 7 (n=18)	12	6	0	-	-	0
8	Problems in relations with others	17	20	7	2	0	0
9	Effect on love life	23	19	3	1	0	0
10	Problems resulting from treatments for skin conditions	17	18	9	1	1	0

Quality of life n (%)
DLQI	Symptoms and feelings	Daily activities	Leisure	Work and school	Interpersonal relations	Treatment
0	9 (19.6%)	13 (28.3%)	14 (30.4%)	36 (78.3%)	17 (37.0%)	17 (37.0%)
1	12 (26.1%)	5 (10.9%)	9 (19.6%)	5 (10.9%)	4 (8.7%)	18 (39.1%)
2	13 (28.3%)	13 (28.3%)	13 (28.3%)	0 (0.0%)	18 (39.1%)	9 (19.6%)
3	8 (17.4%)	5 (10.9%)	6 (13.0%)	5 (10.9%)	3 (6.5%)	2 (4.4%)
4	2 (4.3%)	5 (10.9%)	3 (6.3%)	-	2 (4.3%)	-
5	1 (2.2%)	4 (8.7%)	1 (2.2%)	-	1 (2.2%)	-
6	1 (2.2%)	1 (2.2%)	0 (0.0%)	-	1 (2.2%)	-
Total	46(100.0%)	46(100.0%)	46(100.0%)	46(100.0%)	46 (100.0%)	46(100.0%)

DLQI scores
Characteristics	Not relevant or mild	Moderate, severe, or very severe	odds ratio (95% confidence interval)	p-valueµ
Age (years)
≤ 68	16 (72.7%)	6 (27.3%)	0.70 (IC 0.18-2.73)	0.26
>68	19 (79.2%)	5 (20.8%)
Gender
Male	22 (71.0%)	9 (29.0%)	2.65 (IC 0.49-14.24)	1.47
Female	13 (86.7%)	2 (13.3%)
Work activities
Outdoor	24 (77.4%)	7(22.6%)	0.80 (IC 0.19-3.32)	0.09
Indoor	11 (73.3%)	4 (26.7%)
Fitzpatrick
II	19 (70.4%)	8 (29.6%)	0.44 (IC 0.10-1.96)	1.21
III-IV	16 (84.2%)	3 (15.8%)
Monthly income
≤ 2 minimum wages	28 (73.7%)	10 (26.3%)	0.40 (0.04-3.66)	0.65
2-6 minimum wages	7 (87.5%)	1 (12.5%)
Schooling
Incomplete primary	26 (72.2%)	10 (27.8%)	0.28 (IC 0.03-2.58)	1.56
≥ complete primary	9 (90.0%)	1 (10.0%)
Number of lesions
Single	18 (78.3%)	5 (21.7%)	1.27 (IC 0.32-4.94)	0.11
Multiple	17 (73.9%)	6 (26.1%)
Smoking
Yes	18 (85.7%)	3 (14.3%)	2.82 (IC 0.64-12.44)	1.96
No	17 (68.0%)	8 (32.0%)
Solar exposure 10AM-4PM
Yes	7 (87.5%)	1 (12.5%)	2.50 (IC 0.27-22.93)	0.65
No	28 (73.7%)	10 (26.3%)
Sunscreen
Yes	17 (89.5%)	2 (10.5%)	4.25 (IC 0.80-22.5)	3.44
No	18 (66.7%)	9 (33.3%)
Physical photoprotection
Yes	10 (76.9%)	3 (23.1%)	1.06 (IC 0.23-4.85)	0.007
No	25 (75.8%)	8 (24.2%)
Tumor site
Head\neck	18 (75.0%)	6 (25.0%)	0.88 (IC 0.22-3.43)	0.03
Trunk\limbs	17 (73.3%)	5 (22.7%)

[1] Source: Finlay et al., 1994.¹²

[TFN10] DLQI: Dermatology Life Quality Index. Results with Likert score: 0-1: no effect; 2-5: small effect; 6-10: moderate effect; 11-20: serious effect and 21-30: very serious effect.

Systemic arterial hypertension	21(45.7%)
Diabetes mellitus	5(10.9%)
Rheumatoid arthritis	1(2.2%)
Psoriasis/vitiligo	2(4.4%)
Smoking	25(54.3%)
Pack years*	25(20-40)
Alcohol abuse	20(43.5%)
Solar exposure (years)	44.7±18.3
Exposure between 10:00 AM and 4:00 PM	38(82.6%)
Chemical photoprotection (use of sunscreen)	26 (56.5%)
Mechanical photoprotection (use of hat or long clothing)	33(71.7%)

Influence on quality of life (DLQI)
Not relevant (scores 0-1)		15(32.0%)
Mild (2-5)		20(43.5%)
Moderate (6-10)		6(13.0%)
Severe (11-20)		5(10.9%)
Very severe (21-30)		0(0.0%)
Categorized DLQI
1-5		35(76.1%)
>5		11(23.9%)
Mean DLQI score£		4.02 ± 0.63

Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel*

Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel^*