Quality of Life in Patients Affected by Facial Basal Cell Carcinoma: Prospective Longitudinal Pilot Study and Validation of Skin Cancer Index in Lithuanian Language

Figures & data

Table 1 Patient Sociodemographic Characteristics

Sociodemographic characteristics, n=100
Age	68.35 ± (12.56)
Gender, n (%)
Male	29 (29%)
Female	71 (71%)
Marital status, n (%)
Single	4 (4%)
Dating but living separately	1 (1%)
Married	57 (57%)
Living together with a partner	3 (3%)
Divorced	10 (10%)
Widow/widower	25 (25%)
Education, n (%)
Primary	2 (2%)
Basic (8–10 grades)	6 (6%)
Secondary (11–12 grades)	11 (11%)
Non-university higher education	28 (28%)
University degree	47 (47%)
Other (professional schools)	6 (6%)
Residence, n (%)
Village (<500 inhabitants)	5 (5%)
Town (500–3000 inhabitants)	7 (7%)
City (>3000 inhabitants)	88 (88%)
Employment, n (%)
Employed	31 (31%)
Employed (home office)	1 (1%)
Employed but retired	2 (2%)
Unemployed	8 (8%)
Retired	58 (58%)
Do you have children/close relatives? n (%)
Yes	94 (94%)
No	6 (6%)
Do you often meet them? n (%)
Yes	92 (92%)
No	8 (8%)

Notes: The groups of sociodemographic characteristics are marked in bold.

Table 2 Patient Clinical Characteristics

Clinical characteristics, n=100
Largest tumor diameter, mm	9.22 ± (4.80); range: 3–30
Tumor size groups, n (%)
0–5 mm	21 (21%)
6–10 mm	51 (51%)
11–15 mm	18 (18%)
>15 mm	10 (10%)
Tumor location by TT Fattahi, n (%)
1 Forehead unit	27 (27%)
1a central subunit	8
1b lateral subunit	19
2 Nasal unit	26 (26%)
2.1 tip subunit	8
2.3,6 right and left alar base subunits	7
2.4,5 right and left alar side wall subunits	4
2.7 dorsal subunit	3
2.8,9 right and left dorsal side wall subunits	4
3 Eyelid unit	11 (11%)
3a lower lid subunit	5
3c lateral canthal subunit	1
3d medial canthal subunit	5
4 Cheek unit	28 (28%)
4a medial subunit	16
4b zygomatic subunit	2
4c lateral subunit	4
4d buccal subunit	6
5 Upper lip unit	7 (7%)
5b lateral subunit	7
7 Mental unit	1 (1%)
Surgery groups, n (%)
E	49 (49%)
P	39 (39%)
T	12 (12%)

Notes: Surgery groups: E – primary excision, P – skin-plasty, T – skin transplantation. The groups of clinical characteristics are marked in bold.

Table 3 Internal Consistency of the SCI

Subscale	SCI – I	SCI – II	SCI – III
Emotional	0.912	0.892	0.863
Social	0.705	0.769	0.7
Appearance	0.849	0.904	0.868

Abbreviation: SCI – I, Skin Cancer Index scores at the 1^st visit; SCI– II, Skin Cancer Index scores at the 2^nd visit; SCI – III, Skin Cancer Index scores at the 3^rd visit.

Table 4 Fit Results of the Competing Models Tested (n=100)

	Description	χ^2	Df	RMSEA (95% CI)	CFI	TLI	SRMR
Model 1	Original model (with three factors and 15 items)	163.598	87	0.094 (0.067, 0.12)	0.904	0.884	0.091
Model 2	Original model with one cross-loading item (Q3) as suggested by MI	152.566	86	0.088 (0.06, 0.115)	0.916	0.898	0.079
Model 3	Original model with two cross-loading items (Q3 and Q2) as suggested by MI	139.991	85	0.08 (0.05, 0.108)	0.931	0.915	0.064

Abbreviations: χ², chi squared; df, Degrees of freedom; RMSEA, Root Mean Square Error of Approximation; CI, Confidence Interval; CFI, Comparative Fit Index; TLI, Tucker Lewis Index; SRMR, Standardized Root Mean Squared Residual; Q3, 3^rd question of Skin Cancer Index scale; MI, Modification indices; Q2, 2^nd question of Skin Cancer Index scale.

Figure 1 Graphical representation of the refined model (Model 3), with standardized values.

Table 5 Correlations Between the SCI – I Subscales and the Total Score

	SCI – I Emotional	SCI – I Social	SCI – I Appearance	SCI – I Total
SCI – I Emotional	1
SCI – I Social	0.578 ***	1
SCI – I Appearance	0.374 ***	0.293 **	1
SCI – I Total	0.933 ***	0.715 ***	0.59 ***	1

Notes: Significance: ** - p-value <0.01, *** - p-value <0.001.

Abbreviation: SCI – I, Skin Cancer Index scores at the 1^st visit.

Table 6 Spearman Correlation Coefficients Between SCI – I and WHO-5-I Scores

	WHO-5-1	WHO-5-2	WHO-5-3	WHO-5-4	WHO-5-5	WHO-5 Total
SCI – I Emotional	0.231 *	0.312 **	0.216 *	0.278 **	0.023	0.292 **
SCI – I Social	0.353 ***	0.337 ***	0.293 **	0.21 *	0	0.333 ***
SCI – I Appearance	0.01	0.05	0.126	0.21 *	−0.01	0.12
SCI – I Total	0.261 **	0.33 ***	0.266 **	0.287 **	0.013	0.323 **

Notes: Significance: * - p-value <0.05, ** - p-value <0.01, *** - p-value <0.001.

Abbreviations: SCI – I, Skin Cancer Index scores at the 1^st visit; WHO-5, The World Health Organization- Five Well-Being Index; WHO-5-1, 1^st question of WHO-5; WHO-5-2, 2^nd question of WHO-5; WHO-5-3, 3^rd question of WHO-5; WHO-5-4, 4^th question of WHO-5; WHO-5-5, 5^th question of WHO-5.

Table 7 Spearman Correlation Coefficients Between SCI – I and DLQI Scores

	SCI – I Emotional	SCI – I Social	SCI – I Appearance	SCI – I Total
DLQI 1	−0.299 **	−0.318 **	−0.138	−0.311 **
DLQI 2	−0.207 *	−0.351 ***	−0.182	−0.256 *
DLQI 3	−0.19	−0.246 *	0.036	−0.174
DLQI 4	−0.343 ***	−0.394 ***	−0.036	−0.359 ***
DLQI 5	−0.208 *	−0.225 *	−0.021	−0.167
DLQI 6	−0.154	−0.178	−0.075	−0.152
DLQI 7	−0.014	−0.073	0.206 *	0.016
DLQI 8	−0.152	−0.225 *	−0.021	−0.14
DLQI 9	−0.167	−0.124	−0.018	−0.135
DLQI 10	−0.256 **	−0.115	−0.025	−0.238 *
DLQI Total	−0.355 ***	−0.478 ***	−0.072	−0.365 ***

Notes: Significance: * - p-value <0.05, ** - p-value <0.01, *** - p-value <0.001.

Abbreviation: SCI – I, Skin Cancer Index scores at the 1^st visit; DLQI and the number represents the question of Dermatology Life Quality Index scale respectively.

Table 8 Test–Retest Reliability

	SCI – I Emotional	SCI – I Social	SCI – I Appearance	SCI – I Total
Test	30.16 ± 4.469	22.98 ± 2.308	13.42 ± 1.808	66.56 ± 7.251
Retest	30.08 ± 4.462	23.2 ± 2.148	13.26 ± 1.988	66.54 ± 7.279
ICC (95% CI)	0.81 (0.682; 0.886)	0.84 (0.737; 0.907)	0.88 (0.805; 0.932)	0.83 (0.716; 0.899)
MD (95% CI)	0.08 (−0.696; 0.856)	−0.22 (−0.566; 0.126)	0.16 (−0.093; 0.413)	0.02 (−1.170; 1.210)
SDdif	2.798	1.25	0.912	4.293
SEM	1.22	0.5	0.316	1.77
SDCind	3.381	1.386	0.876	4.906
SDCgroup	0.478	0.196	0.124	0.694
95% LoA	−5.404; 5.565	−2.67; 2.23	−1.627; 1.947	−8.394; 8.434

Abbreviations: SCI – I, Skin Cancer Index score during the 1^st visit; ICC, Intraclass Correlation Coefficient; CI, Confidence Interval; MD, Mean difference score; SD_dif, Standard deviation of differences; SEM, Standard error of measurement; SDC_ind, Smallest detectable change in an Individual; SDC_group, Smallest detectable change in a group; LoA, Limits of agreement.

Table 9 Mean SCI Scores at the 1^st, 2^nd and 3^rd Visits

	SCI – I		SCI – II		SCI – III
	Mean	SD	Mean	SD	Mean	SD
Emotional	25.66	6.27	27.68	5.55	30.55	4.28
Social	22.19	2.98	22.13	3.11	24.04	2.43
Appearance	12.36	2.86	12.60	2.53	14.24	1.69
Total	60.05	10.21	62.41	9.63	68.88	7.50

Abbreviations: SCI – I, Skin Cancer Index scores at the 1^st visit; SCI – II, Skin Cancer Index scores at the 2^nd visit; SCI – III, Skin Cancer Index scores at the 3^rd visit; SD, Standard deviation.

Table 10 Standardized response mean (SRM)

		SRM value	95% CI	p
1^st vs 2^nd visit	SCI Total	0.22	0.04–0.37	0.22
	Emotional	0.40	0.20–0.57	0.04*
	Social	−0.02	−0.23–0.17	0.99
	Appearance	0.09	−0.12–0.30	0.80
1^st vs 3^rd visit	SCI Total	0.79	0.36–1.07	< 0.001***
	Emotional	0.81	0.47–1.04	< 0.001***
	Social	0.48	0.08–0.70	< 0.001***
	Appearance	0.62	0.29–0.79	< 0.001***
2^nd vs 3^rd visit	SCI Total	0.73	0.39–0.95	< 0.001***
	Emotional	0.58	0.34–0.77	< 0.001***
	Social	0.59	0.35–0.76	< 0.001***
	Appearance	0.71	0.40–0.89	< 0.001***

Notes: Significance values of post-hoc ANOVA tests: *p-value <0.05, ***p-value <0.001.

Abbreviation: SRM, Standardized response mean; CI, Confidence Interval.

Table 11 Segment Analysis and SCI Score Differences Across Anatomic Units at the 1^st Visit

	SCI – I Emotional	SCI – I Social	SCI – I Appearance	SCI – I Total
Anatomic Unit	No, p = 0.65	No, p = 0.49	No, p = 0.36	No, p = 0.63 ES small
Gender	Yes, p < 0.05	Yes, p < 0.01	Yes, p < 0.001	Yes, p < 0.001
- Score differences between men and women by anatomic units	No	Yes, eyelid, p = 0.05	Yes, cheek p < 0.001	Yes, cheek, p < 0.05
Age	No, p = 0.70	No, p = 0.87	No, p = 0.06	No, p = 0.49
- Score differences between age groups by anatomic units	Yes, eyelid, p < 0.05	Yes, eyelid, p < 0.05	Yes, eyelid, p < 0.05	Yes, eyelid, p < 0.01
Surgery group (E, P, T)	Yes, p < 0.05	No, p = 0.29	No, p = 0.20	No, p = 0.06
- Score differences between surgery groups by anatomic units	No	Yes, cheek, p < 0.01	No	Yes, p < 0.05 cheek
Size group	No, p = 0.63	No, p = 0.25	No, p = 0.38	No, p = 0.21
- Score differences between size groups by anatomic units	No	No	No	No

Abbreviation: SCI – I, Skin Cancer Index scores at the 1^st visit.

Table 12 Segment Analysis and SCI Score Differences Across Anatomic Units at the 2^nd Visit

	SCI – II Emotional	SCI – II Social	SCI – II Appearance	SCI – II Total
Anatomic Unit	No, p = 0.98	No, p = 0.95	No, p = 0.52	No, p = 0.90
Gender	Yes, p < 0.05	No, p = 0.09	Yes, p < 0.01	Yes, p < 0.05
- Score differences between men and women by anatomic units	No	No	Yes, p < 0.001 cheek	Yes, cheek, p < 0.05
Age	No, p = 0.13	No, p = 0.05	Yes, p < 0.05	No, p = 0.10
- Score differences between age groups by anatomic units	Yes, upper lip, p < 0.05	Yes, nose, p < 0.05	No	No
Surgery group (E, P, T)	No, p = 0.73	No, p = 0.38	No, p = 0.87	No, p = 0.60
- Score differences between surgery groups by anatomic units	No	No	No	No
Size group	No, p = 0.07	No, p = 0.08	No, p = 0.18	Yes, p < 0.05
- Score differences between size groups by anatomic units	No	No	No	No

Abbreviation: SCI – II, Skin Cancer Index scores at the 2^nd visit.

Table 13 Segment Analysis and SCI Score Differences Across Anatomic Units at the 3^rd Visit

	SCI – III Emotional	SCI – III Social	SCI – III Appearance	SCI – III Total
Anatomic Unit	No, p = 0.89	No, p = 0.73	No, p = 0.30	No, p = 0.68
Gender	Yes, p < 0.01	No, p = 0.18	Yes, p < 0.01	Yes, p < 0.05
- Score differences between men and women by anatomic units	Yes, p < 0.01 nose	No	No	No
Age	No, p = 0.06	No, p = 0.33	No, p = 0.14	No, p = 0.09
- Score differences between age groups by anatomic units	No	No	No	No
Surgery group (E, P, T)	No, p = 0.31	No, p = 0.18	No, p = 0.50	No, p = 0.20
- Score differences between surgery groups by anatomic units	No	Yes, p < 0.05 eyelid	No	No
Size group	No, p = 0.27	No, p = 0.61	No, p = 0.29	No, p = 0.43
- Score differences between size groups by anatomic units	No	No	No	No

Abbreviation: SCI – III, Skin Cancer Index scores at the 3^rd visit.

Data Sharing Statement

The data underlying this article will be shared by the corresponding author upon reasonable request.