Exploring Patients’ Perceptions of One-step Surgery for Primary Cutaneous Melanoma: A Qualitative Study
DOI:
https://doi.org/10.2340/actadv.v104.40064Keywords:
Cutaneous Malignant Melanoma, Patient Outcome Assessment, Qualitative Research, Shared Decision Making, Ultrasound ImagingAbstract
High-frequency ultrasonography (> 20 MHz) has allowed for preoperative measurement of melanoma thickness and thus a one-step surgery strategy. The potential benefits of one-step surgery to patients remain unexplored. From June 2022 to August 2023, 2 dermatologists conducted semi-structured individual interviews with patients who had undergone HFUS examination allowing the choice for one-step surgery (group A) and with patients who had had standard two-step surgery (group B). Analysis of interviews with 21 patients (age range 31–81 years) revealed 5 main themes: (a) understanding the diagnosis, highlighting the significance of clear and comprehensive medical explanations; (b) personal factors considered in treatment decisions, including preferences for minimizing surgical procedures; (c) making choices, bearing responsibility, thus showcasing different levels of patient involvement in decision-making; (d) high- frequency ultrasonography reassurance emphasizing the role of medical reassurance, and (e) patient satisfaction, discussing surgical outcomes and the decision-making process. The majority of participants expressed a clear preference for one-step surgery, perceived as a pragmatic and fast surgical strategy while minimizing interventions. In conclusion, the results emphasize the importance of patient-centred care. These insights can guide improved preoperative consultations and enhance shared decision-making between healthcare professionals and patients regarding melanoma treatment strategies.
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, et al. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022. Eur J Cancer 2022; 170: 256-284.
https://doi.org/10.1016/j.ejca.2022.04.018 DOI: https://doi.org/10.1016/j.ejca.2022.04.018
Guillot B, Dalac S, Denis MG, Dupuy A, Emile JF, De La Fouchardiere A, et al. French updated recommendations in Stage I to III melanoma treatment and management. J Eur Acad Dermatol Venereol 2017; 31: 594-602.
https://doi.org/10.1111/jdv.14064 DOI: https://doi.org/10.1111/jdv.14064
Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2019; 80: 208-250.
https://doi.org/10.1016/j.jaad.2018.08.055 DOI: https://doi.org/10.1016/j.jaad.2018.08.055
Fernández Canedo I, de Troya Martín M, Fúnez Liébana R, Rivas Ruiz F, Blanco Eguren G, Blázquez Sánchez N. Preoperative 15-MHz ultrasound assessment of tumor thickness in malignant melanoma. Actas Dermosifiliogr (Engl Ed) 2013; 104: 227-231. DOI: https://doi.org/10.1016/j.adengl.2012.06.025
https://doi.org/10.1016/j.ad.2012.06.007 DOI: https://doi.org/10.1016/j.ad.2012.06.007
Kaikaris V, Samsanavičius D, Maslauskas K, Rimdeika R, Valiukevičienė S, Makštienė J, et al. Measurement of melanoma thickness - comparison of two methods: ultrasound versus morphology. J Plast Reconstr Aesthet Surg 2011; 64: 796-802.
https://doi.org/10.1016/j.bjps.2010.10.008 DOI: https://doi.org/10.1016/j.bjps.2010.10.008
Hinz T, Ehler L-K, Voth H, Fortmeier I, Hoeller T, Hornung T, et al. Assessment of tumor thickness in melanocytic skin lesions: comparison of optical coherence tomography, 20-MHz ultrasound and histopathology. Dermatology 2011; 223: 161-168.
https://doi.org/10.1159/000332845 DOI: https://doi.org/10.1159/000332845
Maj M, Warszawik-Hendzel O, Szymanska E, Walecka I, Rakowska A, Antczak-Marczak M, et al. High frequency ultrasonography: a complementary diagnostic method in evaluation of primary cutaneous melanoma. G Ital Dermatol Venereol 2015; 150: 595-601.
Crisan M, Crisan D, Sannino G, Lupsor M, Badea R, Amzica F. Ultrasonographic staging of cutaneous malignant tumors: an ultrasonographic depth index. Arch Dermatol Res 2013; 305: 305-313.
https://doi.org/10.1007/s00403-013-1321-1 DOI: https://doi.org/10.1007/s00403-013-1321-1
Botar-Jid CM, Cosgarea R, Bolboacă SD, Şenilă SC, Lenghel LM, Rogojan L, et al. Assessment of cutaneous melanoma by use of very-high-frequency ultrasound and real-time elastography. AJR Am J Roentgenol 2016; 206: 699-704.
https://doi.org/10.2214/AJR.15.15182 DOI: https://doi.org/10.2214/AJR.15.15182
Machet L, Belot V, Naouri M, Boka M, Mourtada Y, Giraudeau B, et al. Preoperative measurement of thickness of cutaneous melanoma using high-resolution 20 MHz ultrasound imaging: a monocenter prospective study and systematic review of the literature. Ultrasound Med Biol 2009; 35: 1411-1420.
https://doi.org/10.1016/j.ultrasmedbio.2009.03.018 DOI: https://doi.org/10.1016/j.ultrasmedbio.2009.03.018
Meyer N, Lauwers-Cances V, Lourari S, Laurent J, Konstantinou MP, Lagarde JM, et al. High-frequency ultrasonography but not 930-nm optical coherence tomography reliably evaluates melanoma thickness in vivo: a prospective validation study. Br J Dermatol 2014; 171: 799-805.
https://doi.org/10.1111/bjd.13129 DOI: https://doi.org/10.1111/bjd.13129
Mušič MM, Hertl K, Kadivec M, Pavlović M, Hočevar M. Pre-operative ultrasound with a 12-15 MHz linear probe reliably differentiates between melanoma thicker and thinner than 1 mm. J Eur J Dermatol Venereol 2010; 24: 1105-1108.
https://doi.org/10.1111/j.1468-3083.2010.03587.x DOI: https://doi.org/10.1111/j.1468-3083.2010.03587.x
Vilana R, Puig S, Sanchez M, Squarcia M, Lopez A, Castel T, et al. Preoperative assessment of cutaneous melanoma thickness using 10-MHz sonography. AJR Am J Roentgenol 2009; 193: 639-643.
https://doi.org/10.2214/AJR.08.1387 DOI: https://doi.org/10.2214/AJR.08.1387
Guitera P, Li LX, Crotty K, Fitzgerald P, Mellenbergh R, Pellacani G, et al. Melanoma histological Breslow thickness predicted by 75-MHz ultrasonography. Br J Dermatol 2008; 159: 364-369.
https://doi.org/10.1111/j.1365-2133.2008.08681.x DOI: https://doi.org/10.1111/j.1365-2133.2008.08681.x
Hayashi K, Koga H, Uhara H, Saida T. High-frequency 30-MHz sonography in preoperative assessment of tumor thickness of primary melanoma: usefulness in determination of surgical margin and indication for sentinel lymph node biopsy. Int J Clin Oncol 2009; 14: 426-430.
https://doi.org/10.1007/s10147-009-0894-3 DOI: https://doi.org/10.1007/s10147-009-0894-3
Tchernev G. One step surgery for cutaneous melanoma: "We cannot solve our problems with the same thinking we used when we created them?". Open Access Maced J Med Sci 2017; 5: 774-776.
https://doi.org/10.3889/oamjms.2017.168 DOI: https://doi.org/10.3889/oamjms.2017.168
Chaput L, Laurent E, Pare A, Sallot A, Mourtada Y, Ossant F, et al. One-step surgical removal of cutaneous melanoma with surgical margins based on preoperative ultrasound measurement of the thickness of the melanoma. Eur J Dermatol 2018; 28: 202-208.
https://doi.org/10.1684/ejd.2018.3298 DOI: https://doi.org/10.1684/ejd.2018.3298
Russo-de la Torre F. One-step surgical removal of a cutaneous melanoma: current evidence. Actas Dermosifiliogr (Engl Ed) 2020; 111: 541-544. DOI: https://doi.org/10.1016/j.adengl.2019.02.026
https://doi.org/10.1016/j.ad.2019.02.019 DOI: https://doi.org/10.1016/j.ad.2019.02.019
Albrecht KJ, Nashan D, Meiss F, Bengel J, Reuter K. Shared decision making in dermato-oncology: preference for involvement of melanoma patients. Melanoma Res 2014; 24: 68-74.
https://doi.org/10.1097/CMR.0000000000000030 DOI: https://doi.org/10.1097/CMR.0000000000000030
Van der Horst DEM, Garvelink MM, Bos WJW, Stiggelbout AM, Pieterse AH. For which decisions is Shared Decision Making considered appropriate? - A systematic review. Patient Educ Couns 2023; 106: 3-16.
https://doi.org/10.1016/j.pec.2022.09.015 DOI: https://doi.org/10.1016/j.pec.2022.09.015
O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med 2014; 89: 1245-1251.
https://doi.org/10.1097/ACM.0000000000000388 DOI: https://doi.org/10.1097/ACM.0000000000000388
Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Evaluation 2006; 27: 237-246.
https://doi.org/10.1177/1098214005283748 DOI: https://doi.org/10.1177/1098214005283748
Tamirisa NP, Goodwin JS, Kandalam A, Linder SK, Weller S, Turrubiate S, et al. Patient and physician views of shared decision making in cancer. Health Expect 2017; 20: 1248-1253.
https://doi.org/10.1111/hex.12564 DOI: https://doi.org/10.1111/hex.12564
Loescher LJ, Crist JD, Siaki LACL. Perceived intra-family melanoma risk communication. Cancer Nurs 2009; 32: 203-210.
https://doi.org/10.1097/NCC.0b013e31819ae11c DOI: https://doi.org/10.1097/NCC.0b013e31819ae11c
Mulley AG, Trimble C, Elwyn G. Stop the silent misdiagnosis: patients' preferences matter. BMJ 2012; 345: e6572.
https://doi.org/10.1136/bmj.e6572 DOI: https://doi.org/10.1136/bmj.e6572
Hultstrand Ahlin C, Hörnsten Å, Coe A-B, Lilja M, Hajdarevic S. Wishing to be perceived as a capable and resourceful person - a qualitative study of melanoma patients' experiences of the contact and interaction with healthcare professionals. J Clin Nurs 2019; 28: 1223-1232.
https://doi.org/10.1111/jocn.14730 DOI: https://doi.org/10.1111/jocn.14730
Lee EH, Klassen AF, Lawson JL, Scott AM, Pusic AL. Patient experiences and outcomes following facial skin cancer surgery: a qualitative study. Australas J Dermatol 2016; 57: e100-e104.
https://doi.org/10.1111/ajd.12323 DOI: https://doi.org/10.1111/ajd.12323
Nuttall P, Fothergill A, Hemington-Gorse SJ, Dobbs TD, Tree JJ. Letter to the Editor: Confronting the psychological challenges of skin cancer: a qualitative study investigating patient's experience of a skin cancer diagnosis and support received. J Plast Reconstr Aesthet Surg 2023; 83: 301-304.
https://doi.org/10.1016/j.bjps.2023.05.041 DOI: https://doi.org/10.1016/j.bjps.2023.05.041
Vogel RI, Strayer LG, Ahmed RL, Blaes A, Lazovich D. A qualitative study of quality of life concerns following a melanoma diagnosis. J Skin Cancer 2017; 2017: 2041872.
https://doi.org/10.1155/2017/2041872 DOI: https://doi.org/10.1155/2017/2041872
Bird J, Coleman P, Danson S. Coping with melanoma-related worry: a qualitative study of the experiences and support needs of patients with malignant melanoma. J Clin Nurs 2015; 24: 937-947.
https://doi.org/10.1111/jocn.12758 DOI: https://doi.org/10.1111/jocn.12758
Wolner ZJ, Flowers NI, Yushak ML, Chen SC, Yeung H. Exploring the melanoma survivorship experience: a qualitative study. Br J Dermatol 2021; 185: 221-223.
https://doi.org/10.1111/bjd.19868 DOI: https://doi.org/10.1111/bjd.19868
Stamataki Z, Brunton L, Lorigan P, Green AC, Newton-Bishop J, Molassiotis A. Assessing the impact of diagnosis and the related supportive care needs in patients with cutaneous melanoma. Support Care Cancer 2015; 23: 779-789.
https://doi.org/10.1007/s00520-014-2414-x DOI: https://doi.org/10.1007/s00520-014-2414-x
Kučinskienė V, Samulėnienė D, Gineikienė A, Raišutis R, Kažys R, Valiukevičienė S. Preoperative assessment of skin tumor thickness and structure using 14-MHz ultrasound. Medicina (Kaunas) 2014; 50: 150-155.
https://doi.org/10.1016/j.medici.2014.08.002 DOI: https://doi.org/10.1016/j.medici.2014.08.002
Crisan D, Kastler S, Scharffetter-Kochanek K, Crisan M, Schneider L-A. Ultrasonographic assessment of depth infiltration in melanoma and non-melanoma skin cancer. J Ultrasound Med 2023; 42: 1609-1616.
https://doi.org/10.1002/jum.16180 DOI: https://doi.org/10.1002/jum.16180
Leong WL, Ghazarian DM, McCready DR. Previous wide local excision of primary melanoma is not a contraindication for sentinel lymph node biopsy of the trunk and extremity. J Surg Oncol 2003; 82: 143-146.
https://doi.org/10.1002/jso.10205 DOI: https://doi.org/10.1002/jso.10205
Gannon CJ, Rousseau DL, Ross MI, Johnson MM, Lee JE, Mansfield PF, et al. Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma. Cancer 2006; 107: 2647-2652.
https://doi.org/10.1002/cncr.22320 DOI: https://doi.org/10.1002/cncr.22320
Vaidya TS, Bander TS, Musthaq S, Lampley N, Lee EH, Nehal KS, et al. Validation of a patient decision aid for the treatment of lentigo maligna. J Am Acad Dermatol 2021; 84: 1751-1753.
https://doi.org/10.1016/j.jaad.2020.10.043 DOI: https://doi.org/10.1016/j.jaad.2020.10.043
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