Background

Surgical treatment options for facial melanomas include conventional excision with postoperative margin assessment, Mohs micrographic surgery (MMS) with immunostains (MMS-I), and slow MMS. Patient preferences for these surgical options have not been studied.

Objectives

To evaluate patient preferences for surgical treatment of facial melanoma and to determine how patients value the relative importance of different surgical attributes.

Methods

Participants completed a 2-part study consisting of a stated preference survey and a choice-based conjoint analysis experiment.

Results

Patients overwhelmingly (94.3%) rated local recurrence risk as very important and ranked it as the most important attribute of surgical treatment for facial melanoma. Via choice-based conjoint analysis, patients ranked the following surgical attributes from highest to lowest in importance: local recurrence rate, out-of-pocket cost, chance of second surgical visit, timing of reconstruction, travel time, and time in office for the procedure. Consistent with their prioritization of low local recurrence rates, more than 73% of respondents selected MMS-I or slow MMS as their preferred treatment option for a facial melanoma.

Limitations

Data were obtained from a single health system.

Conclusion

Patients prefer surgical treatment options that minimize risk for local recurrence. Logistics for travel and treatment have less influence on patient preferences. Most survey participants chose MMS-I to maximize local cure and convenience of care.

中文翻译：

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对于面部黑色素瘤的手术治疗，患者将局部复发风险置于其他属性之上—一项明确的偏好调查和基于选择的联合分析的结果

背景

面部黑素瘤的手术治疗选择包括常规切除术和术后边缘评估，带免疫染色的Mohs显微外科手术（MMS）（MMS-1）和慢MMS。尚未研究患者对这些手术选择的偏好。

目标

评估患者对面部黑素瘤手术治疗的偏好，并确定患者如何评价不同手术属性的相对重要性。

方法

参与者完成了一个分为两部分的研究，包括陈述的偏好调查和基于选择的联合分析实验。

结果

绝大多数患者（94.3％）认为局部复发风险非常重要，并将其列为面部黑色素瘤手术治疗的最重要属性。通过基于选择的联合分析，患者对以下手术属性的重要性从高到低进行了排名：局部复发率，自付费用，第二次手术的机会，重建的时间，出差时间和就诊时间程序。与优先考虑低局部复发率一致，超过73％的受访者选择了MMS-I或慢MMS作为面部黑色素瘤的首选治疗选择。

局限性

数据是从单个卫生系统获得的。

结论

患者更喜欢手术治疗方案，以最大程度地减少局部复发的风险。旅行和治疗的后勤对患者偏好的影响较小。大多数调查参与者选择MMS-I以最大程度地提高局部治愈率和护理便利性。