In a study of patients being treated with surgery for skin cancer, researchers found that a perception of surgical delay may be linked to a greater time between biopsy and surgery and an increased level of anxiety. The researchers reported their findings in the journal Dermatologic Surgery.

“Understanding causes of patient anxiety is important because perioperative anxiety has been associated with worse outcomes, increased pain, and decreased patient satisfaction,” the study researchers explained in their report.

Patients who were eligible for inclusion in this single-institution study were undergoing either wide local excision or Mohs micrographic surgery for skin cancer. The researchers performed chart reviews to identify patients’ demographic and surgical characteristics, and they surveyed patients for their perceptions of surgical delay and anxiety. The survey included the Psychosocial Screen for Cancer-Revised (PSSCAN-R). The research team analyzed patterns in patient demographic and surgical characteristics in conjunction with survey results.

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A total of 124 patients who met the eligibility criteria completed the survey. Participants were mean age 66.8 years. Self-reports indicated 15% had a history of depression, 9% had a history of anxiety, and 12% had a history of both. More than one-fourth (27%) reported that they perceived a delay in their surgery. 

Demographic characteristics did not appear to differ between patients who perceived a delay in surgery and those who did not. There also were no differences seen in self-reported anxiety or depression history, surgery type, tumor type, or past history of skin surgery between the 2 groups of patients. 

However, the number of days between biopsy and treatment was significantly greater for patients who perceived a surgical delay, compared with those who did not perceive a delay (P <.0001). Additionally, the researchers found that the PSSCAN–R validated anxiety score, adjusted for several variables, was higher in patients perceiving a surgical delay, compared with patients not perceiving a delay (P =.038). 

The researchers concluded that patient perceptions of surgical delay in this study were correlated with the time between biopsy and surgery, and were associated with PSSCAN–R anxiety scores. They also noted that anxiety regarding surgery can affect outcomes and patient satisfaction. They recommended additional research on alleviating anxiety regarding skin cancer surgery and suggested that educating patients on timeframes regarding surgical treatments may alter a perception of surgical delay and possibly reduce related anxiety. 


Daly CM, Scott JF, Bibee KP. Patient anxiety related to patient-perceived delays in surgical treatment of skin cancer. Dermatol Surg. Published online January 31, 2023. doi:10.1097/DSS.0000000000003716