Depression Following Facial Mohs Micrographic Surgery Characterized

Patients can experience symptoms of depression during the immediate postoperative period following Mohs micrographic surgery (MMS) despite the high efficacy and success of the technique, according to findings presented at the 2021 Fall Scientific Symposium of the American Society of Ophthalmic Plastic and & Reconstructive Surgery. The study indicated that patients who underwent facial MMS did not experience symptoms as great as patients treated with MMS at other sites.

Researchers from Columbia University Irving Medical Center and Icahn School of Medicine at Mount Sinai in New York, NY, sought to quantify rates of depressive symptoms in the short-term postoperative period following MMS. Their prospective cohort study included 43 patients (average age 65 years, 53% women) undergoing MMS in 2 high-volume practices. Prior to undergoing the procedures, participants provided their medical history and completed a modified Patient Health Questionnaire 8 (PHQ-8). Postoperatively, the same questionnaire was administered at 1, 2, 4, 6, and 12 weeks and the changes in PHQ-8 scores were evaluated against baseline PHQ-8 values. PHQ-8 scores ranged from 0 to 24, with a cutoff for clinical depression at a score greater than 5. 

At baseline, the average PHQ-8 score was 1.23±2.16. A total of 74% of participants had facial malignancies removed. Eighteen (42%) of participants did have an increase in score during the 12-week follow-up period, and of these patients 11 (61%) had undergone facial MMS. A significant elevation in PHQ-8 scores was identified from baseline (P =0) at week 2 (1.70 ±2.48) and week 4 (1.70 ±2.48), which equates to a point increase between 1 and 6 on the PHQ-8 score. Despite this increase, from baseline to week 12, the PHQ-8 score average returned to 1.20 ±1.95. 

For participants with MMS performed on a lower-extremity site, compared with other anatomic locations including the face, significantly higher average PHQ-8 scores were encountered at week 4 (P =.02) and there was a significantly increased change from baseline scores at weeks 2 (P =.01), 4 (P =0), and 6 (P =.04).

Data from this study suggest that in the weeks following MMS, some patients may be at increased risk for experiencing transient depressive symptoms. with the highest peak of symptoms occurring in the 2- to 4-week period post procedure. Individuals with lower-extremity lesions appeared to have significantly higher scores than those who received MMS for other anatomic sites. The investigators suggest that this difference may be due to the greater impact of lower-extremity MMS on daily activity and mobility. 

The researchers explained that the finding that patients who underwent facial MMS did not show a similar significant increase in depressive symptoms may be due to the COVID-19 pandemic, with a facial MMS site having less of an impact due to masking and already decreased socialization. Ultimately, they said, evaluation of patients’ emotional state in the postoperative period following MMS is key to improving the patient experience and psychological outcomes. 

Reference

Kassotis AS, Shin S, Samie FH, Lewin JM, Levenson JA, Dagi Glass LR. Quantification and identification of risk factors for the development of transient depressive symptoms after Mohs micrographic surgery. Poster presented at: American Society of Ophthalmic Plastic and Reconstructive Surgery 52nd Annual Fall Scientific Symposium; November 11-12, 2021; New Orleans.