Reconstruction of Mohs Facial Defects: A Conjoint Analysis of Patient Priorities

Introduction: Reconstruction of Mohs micrographic surgery (MMS) facial defects can be safely performed in the clinic or operating room, and location of repair is often decided by the surgeon and/or patient. While prior studies have shown that both locations offer good patient outcomes, there remains a paucity of studies aimed at understanding the patient perspective and experience during MMS repair.

Methods: This was a prospective, survey-based study utilizing conjoint analysis, a strategy used in business market research to measure the value placed on particular product features. Sawtooth Software (Lighthouse Studio) was used to create a decision-making survey with 8 specified attributes of interest pertinent to reconstruction of a nasal MMS defect. Surveys were administered to patients on the day of a facial MMS defect reconstruction procedure between January and December 2023.

Results: In total, 141 patients (average age 70.8 years, 61.7% male) completed the survey. Of these, 23 cases were performed in the operating room and 118 in clinic. The attributes were scored with overall importance scores as follows: functional outcomes 30.7 (± 8.8), aesthetics 29.2 (± 9.5), staging 9.8 (± 4.7), awareness/anxiety 7.9 (± 5.2), medical risk 7.1 (± 4.5), convenience 6.8 (± 4.7), time commitment 5.1 (± 3.1), and pain 3.5 (± 2.8). On an individual level, the vast majority of patients scored functional outcomes (N = 73) and aesthetics (N = 65) as most important, while 72 patients found pain to be the least important factor.

Conclusions: These findings suggest that patients considering reconstruction of a nasal MMS defect place highest value on achieving excellent functional and aesthetic outcomes, even if it requires increased discomfort during the procedure, increased time commitment, NPO status and assisted transport to/from the procedure, or a higher medical risk. Ongoing analysis will focus on predicting such patient priorities using sociodemographic factors. Overall, patients benefit from nuanced discussion of the risks and benefits of procedural locations in order understand what is required to achieve the best clinical outcome.