Is Less Truly More? The Laissez-Faire Approach: Evaluating Patient and Clinician Perspectives on Scar Satisfaction and Aesthetic Outcomes Following Medial Canthal BCC Excision
Author: Ka Wai Leung
Base Hospital / Institution: Hampshire Hospitals NHS Foundation Trust
ePoster presentation
Abstract ID: 25-416
Purpose
To assess long-term cosmetic, functional, and psychometric outcomes of the laissez-faire technique for healing surgical wounds following basal cell carcinoma (BCC) excision in the medial canthal region, from both patient and clinician perspectives.
Methods
A single-centre, retrospective study included patients operated on by a single surgeon between September 2021 and September 2024. Inclusion criteria were histologically confirmed medial canthal BCCs managed with the laissez-faire approach. Exclusion criteria were surgical closure, flap reconstruction, death, or loss to follow-up. Patient-reported outcomes were assessed using the Patient Scar Assessment Questionnaire (PSAQ) and the patient component of the Patient and Observer Scar Assessment Scale (POSAS). Clinician-reported outcomes were rated by two experts and two non-experts using the Manchester Scar Scale (MSS) based on standardised postoperative photographs. Statistical analyses included Pearson’s correlation (r), t-tests, and intraclass correlation coefficients (ICC), conducted in R® and Excel.
Results
Twenty-two patients (mean age 69.2 ± 2.4; 16 White) were included. Most BCCs were nodular (n = 17). Mean size of main specimen was 10.8 × 8.6 × 3.4 mm. MSS scores improved with scar age (r = –0.67, p ≤ .001) and were significantly better in photos taken ≥12 weeks post-op (p ≤ .001). No significant difference was found pre- and post-repeat biopsy (p ≥ .993). ICC was excellent among experts (0.994 [0.985–0.997]) and good among non-experts (0.769 [0.322–0.915]). Mean MSS score was 7.01 ± 0.75. Mean POSAS scores were 7.77 ± 0.64 (current) and 11.18 ± 0.58 (past week); 90.5% were very satisfied. Mean PSAQ subscale scores were favourable, with low mean overall scores indicating minimal scar burden.
Conclusion
The laissez-faire technique yielded favourable cosmetic, functional, and psychometric outcomes following medial canthal BCC excision. Further prospective studies across larger, ethnically diverse cohorts are warranted. This technique offers a promising, low-morbidity alternative for reconstruction in this anatomically complex region.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Monisha | Meena | Hampshire Hospitals NHS Foundation Trust |
| Wei-Shan | Tsai | Hampshire Hospitals NHS Foundation Trust |
| Bhavna | Sharma | Hampshire Hospitals NHS Foundation Trust |
| ST | Nagendran | Hampshire Hospitals NHS Foundation Trust |
