Patients prioritize local recurrence risk over other attributes for surgical treatment of facial melanomas—Results of a stated preference survey and choice-based conjoint analysis - 16/07/18

Doi : 10.1016/j.jaad.2018.02.059

Jeremy R. Etzkorn, MD ^a,^⁎ , Scott D. Tuttle, BS ^b, Ilya Lim, MD ^c, Elea M. Feit, PhD ^d, Joseph F. Sobanko, MD ^a, Thuzar M. Shin, MD, PhD ^a, Donald E. Neal, BA ^e, Christopher J. Miller, MD ^a
^a Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
^b Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
^c Department of Dermatology, Yale University, New Haven, Connecticut
^d Lebow College of Business, Drexel University, Philadelphia, Pennsylvania
^e Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

^∗Correspondence to: Jeremy R. Etzkorn, MD, Mohs & Reconstructive Surgery, Division of Dermatologic Surgery, University of Pennsylvania Health System, 3400 Civic Center Blvd, Philadelphia, PA 19104.Mohs & Reconstructive Surgery, Division of Dermatologic SurgeryUniversity of Pennsylvania Health System3400 Civic Center BlvdPhiladelphiaPA19104

Abstract

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.

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Key words : choice-based conjoint analysis, delayed reconstruction, immediate reconstruction, immunostaining, incomplete excision, local recurrence wide local excision, margins of excision, melanoma, Mohs micrographic surgery, patient preference, positive margins, Sawtooth Discover

Abbreviations used : CBCA, CE-POMA, MMS, MMS-I

Plan

Stated preference survey

CBCA

Discussion

	Funding sources: Dr Etzkorn and Dr Sobanko are supported by a Dermatology Foundation Clinical Career Development Award in Dermatologic Surgery.
	Conflicts of interest: None disclosed.
	Reprints not available from the authors.