Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Institute of Life Science 2, Swansea University Medical School, Swansea, U.K.
The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, U.K.
Br J Dermatol. 2019 May;180(5):1018-1029. doi: 10.1111/bjd.17342. Epub 2018 Dec 19.
Skin cancer is the commonest malignancy worldwide, often occurring on the face. Both the condition and treatment can lead to scarring and facial disfigurement, affecting a patient's health-related quality of life (HRQoL), which can be measured using patient-reported outcome measures (PROMs).
This systematic review identifies PROMs for facial skin cancer and appraises their methodological quality and psychometric properties using up-to-date methods.
MEDLINE, Embase, PsycINFO, Cochrane and CINAHL were searched systematically in accordance with PRISMA guidelines, identifying all PROMs designed for or validated in facial skin cancer. Methodological quality and evidence of psychometric properties were assessed using the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) checklist and criteria proposed by Terwee and colleagues. A best-evidence synthesis and assessment of instrument focus on post-resection reconstruction was also performed.
We included 24 studies on 11 PROMs. Methodological quality and psychometric evidence was variable, with the Patient Outcome of Surgery - Head/Neck (POS-H/N), Skin Cancer Index (SCI), Skin Cancer Quality of Life Impact Tool (SCQOLIT) and Essers and colleagues demonstrating the greatest level of validation. None scored well in their relevance to post-skin cancer reconstruction of the face.
This systematic review critically appraises PROMs for facial skin cancer using internationally accepted criteria. The identified PROMs demonstrate a variation in the quality of validation performed, with a need to improve this across all PROMs in the field. Only through improving the quality of available PROMs and their focus on the post-treatment aesthetic and functional outcome will we be able to truly appreciate the concerns of our patients and improve the management of facial skin cancer.
皮肤癌是全球最常见的恶性肿瘤，常发生于面部。疾病本身及其治疗均可导致瘢痕和面部毁容，影响患者的健康相关生活质量（HRQoL），可通过患者报告的结局测量（PROMs）进行评估。
本系统评价旨在确定用于评估面部皮肤癌的 PROMs，并使用最新方法评估其方法学质量和心理测量学特性。
根据 PRISMA 指南，系统检索 MEDLINE、Embase、PsycINFO、Cochrane 和 CINAHL，以确定专门用于或经面部皮肤癌验证的所有 PROM。使用共识基础的健康测量仪器选择标准（COSMIN）清单和特维尔特同事提出的标准评估方法学质量和心理测量学特性的证据。还进行了最佳证据综合和对术后重建重点的评估。
我们纳入了 24 项研究的 11 种 PROM。方法学质量和心理测量学证据各不相同，其中患者手术结局 - 头颈部（POS-H/N）、皮肤癌指数（SCI）、皮肤癌生活质量影响工具（SCQOLIT）和埃瑟斯等人的研究显示出最大程度的验证。没有一个在与面部皮肤癌重建的相关性方面表现出色。
本系统评价使用国际公认的标准对用于评估面部皮肤癌的 PROM 进行了严格评价。所确定的 PROM 在进行验证的质量方面存在差异，需要在该领域的所有 PROM 中均提高这一质量。只有通过提高现有 PROM 的质量并将其重点放在治疗后美学和功能结果上，我们才能真正了解患者的关注点，并改善面部皮肤癌的管理。
