Skin cancer, particularly non-melanoma skin cancer (NMSC), represents a significant healthcare burden globally. Correct clinical diagnosis can be challenging with patients being misdiagnosed and having unnecessary surgery or delays in treatment. Punch biopsies offer a minimally invasive method to establish the diagnosis prior to treatment. This study correlates clinical appearance with histological diagnosis post punch biopsy and reflects on its value in the patient pathway. This single-unit study evaluated 200 consecutive punch biopsies of 137 suspected NMSC patients. Data were analysed for demographic factors, clinical appearances, histopathological results, subsequent management, and time between these events. The clinical diagnoses were 124 basal cell carcinoma (BCC), 36 squamous cell carcinoma (SCC), one lentigo maligna, one Merkel cell tumour, and 38 benign lesions. Overall clinical diagnosis and punch biopsy histology were the same in 86 cases (43%). In 89 of 162 NMSC cases (55.6%) the punch biopsy diagnosis avoided further surgery. In 10 cases (5%) it was necessary to expedite surgical intervention where SCC or BCC were unexpectedly diagnosed. Correct clinical diagnosis for BCC and SCC was 41.9% and 30.6%, respectively, underscoring the importance of histological confirmation in cases where clinical diagnosis is uncertain. Twenty-five punch biopsies were for dermatology referrals, and concordance was 12 (48%). Punch biopsy did not delay treatment as time from clinical assessment to biopsy result was mean (SD) 19.1 (16.3) days. This study highlights that the benefit of punch biopsies, which helped clarify the diagnosis for both the patient and surgeon, improved diagnostic accuracy, and avoided inappropriate use of theatre time with associated patient burden and morbidity.

Introduction: Head and neck cancer (HNC) treatments often lead to significant post-treatment side effects that affect patients’ quality of life. This study aimed to translate and validate the post-treatment Patient Concerns Inventory for head and neck (PCI-HN) into Arabic among HNC survivors. Methods: This study employed a cross-sectional design, where PCI-HN was translated and assessed for content and face validity by clinical experts and patients, respectively. Revisions to multiple items related to ‘social and religious welfare’. Patients’ responses were then analysed to assess internal consistency (Cronbach’s alpha) and test–retest reliability (Cohen’s Kappa). Results: Thirty-eight participants (19 males, 19 females, mean age 50.68 ± 16.13 years) were included. The Arabic PCI-HN demonstrated good overall internal consistency (α = 0.723) but fair test–retest agreement (κ = 0.22), likely reflecting dynamic changes in HNC post-treatment experiences. Conclusion: The Ar-PCI-HN can be a helpful instrument for capturing distinct aspects of the survivorship experience among Arabic-speaking HNC survivors. Determining the clinical interpretability and ability to detect changes over time requires further multi-centre and multi-country clinical studies. This would be necessary to ensure its integration into routine outpatient consultations for Arabic-speaking patients in Arab countries and globally.

Melanoma and non-melanoma skin cancers are among the most commonly diagnosed malignancies globally, with incidence rates continuing to rise. Patients with facial skin cancer frequently experience significant psychosocial distress, including anxiety and concerns about appearance, which adversely affect their quality of life. However, the supportive care needs of this population during diagnosis and treatment remain poorly understood, leading to missed opportunities for meaningful intervention during clinical consultations. Current patient-reported outcome measures are insufficient to fully capture the nuanced and holistic concerns specific to this group. This article aims to summarise on the factors contributing to experiences, needs, and concerns of patients with facial skin cancer in published literature. A broad literature search was undertaken using targeted keywords related to facial skin cancer and patient experience. Findings reveal a diverse and complex range of unmet needs, often varying across specific patient subgroups, which underscores the highly individualised nature of patient experiences. This variability presents challenges in identifying consistent, overarching themes, and highlights a critical gap in the current clinical focus on holistic care. While this paper identifies key areas warranting further exploration, it also highlights the key absence of a systematic approach to understanding patient experiences in this context. Further research is essential to comprehensively characterise these needs and inform the development of tailored clinical tools to support more effective, patient-centred care.

Penetrating neck injury (PNI) describes an injury, typically with a sharp object, resulting in a wound that crosses platysma. These injuries often require surgical exploration and may result in significant morbidity and mortality. We undertook, to our knowledge, the first systematic analysis of the literature exploring the psychological impact of PNI, and carried out a thematic analysis. An electronic search of five databases and four registers was performed in March 2025 according to PRISMA guidelines. Quality of the studies was assessed using Critical Appraisal Skills Programme (CASP) checklists. Thematic analysis was conducted using NVivo software (Lumivero). Of 974 identified studies, 30 met the inclusion criteria, in which 651 patients with PNI were described. Three key themes were identified: aetiology of PNI drives treatment need; psychiatric care is central to multidisciplinary management; and PNI occurs in a socioeconomic context. Patients who self-injure typically receive psychiatric treatment and/or medication, and those with traumatic injuries may receive psychotherapy. Quality of the studies was moderate, with an absence of targeted or prospective research. Current treatment for the psychological impact of PNI is classified by aetiology, though the literature remains heterogeneous and incomplete. Studies note a strong association with socioeconomic deprivation. Psychiatric care is a central component of multidisciplinary management, particularly due to the risk of serious self-harm or suicide following PNI. Presentation with acute injuries offers oral and maxillofacial (OMFS) surgeons an opportunity to prevent further injury and death with timely referral to psychiatric teams. Targeted prospective research would enable optimal assessment and support for recovery in these patients.

Head and neck cancers (HNC) are devastating, thus imposing a negative impact on the appearance of an individual as well as vital activities such as eating, swallowing, speaking, and breathing. Therefore, HNC patients undergo distress, while their caregivers become overburdened. Religion and spirituality can be helpful for patients and their caregivers from diverse cultural backgrounds to cope with cancer. Though well established in palliative care, religion and spirituality are rarely incorporated into usual early oncological care. Despite the availability of heterogeneous literature examining the influence of religion and spirituality on cancer patients, there is notably limited research on this topic across the HNC trajectory. Therefore, this scoping review attempts to answer “What is the influence of religion or spirituality on HNC patients and their caregivers in different contexts?” and will map the evidence on the influence of religion and spirituality on HNC patients and their caregivers in different contexts including geographical areas, cultures, health care systems, and different study settings. This scoping review was formulated using the guidelines of Joanna Briggs Institute (JBI) manual for evidence synthesis: scoping reviews and will be reported confirming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR checklist). A comprehensive search strategy will include Embase, CINAHL, Scopus, and APA PsycINFO. The OPENGREU.EU and Google Scholar will be used as gray literature sources complimented by manual searches. Our eligibility criteria follow the population, concept, and context (PCC) framework. Patients aged ≥ 18 years diagnosed with HNC and their informal, nonpaid caregivers aged > 18 years will be included. The data will be extracted using piloted data extraction form on sociodemographic, disease-related, and treatment-related factors and outcomes, and the data will be analyzed through descriptive statistics and thematic analysis. The results will be narratively synthesized. This review will aim to explore existing literature and summarize the findings of studies that examine the influence of religion and spirituality among HNC patients and their caregivers and vice versa over a range of physical, psychological, and social outcomes including quality of life. We also aim to identify existing research gaps. The findings of this review would generate evidence to better inform health care providers in countries and cultures in the management of patients diagnosed with HNC in usual oncological care with due consideration to caregivers.

Head and neck cancer (HANC) patients' health-related quality of life and concerns shape the patient-clinician interaction. Allowing patients to raise concerns that might otherwise be missed affords an opportunity for intervention and signposting to multiprofessional rehabilitation services. The Patient Concerns Inventory (PCI-HN) is a simple, condition-specific tool that promotes holistic, patient-centred consultation. This paper aims to summarise the findings from PCI use in routine clinics in Nottingham and report PCI profiles based on cancer site, surgical treatment, adjuvant radiotherapy (RT), time since surgery, and Speech and language therapy (SALT) frequency of follow up. From October 2020 to March 2022, 102 HANC patients undergoing curative surgery attended follow ups at Queen's Medical Centre, Nottingham. A total of 242 PCI-HN forms were completed, as some had multiple consultations. The cohort included 38 females and 64 males (aged 31-93). Most had oral cancer (83%), followed by oropharyngeal (12%) and other HANC (5%). The most common concerns were dental health/teeth (26%), chewing/eating (21%), fear of recurrence (21%) and dry mouth (21%). Concern patterns varied, notably, oral and oropharyngeal cancer patients prioritised dental health, free flap (FF) reconstruction patients focused on physical/functional wellbeing, and RT patients cited chewing/eating (36%) versus non-RT patients who feared recurrence (20%). FF and RT patients required more frequent SALT rehabilitation. PCI-HN captured diverse patient concerns, varying by site, surgery type, adjuvant RT, and time since surgery. Findings support targeted, stratified follow-up care.

Head and neck cancer (HaNC) can be debilitating, resulting in high symptom burden. Physical activity (PA) can improve quality of life; however, less than 9

ObjectiveTo determine the feasibility and acceptability of integrating a remote, personalised, collaborative, and flexible exercise programme into the head and neck cancer (HNC) care pathway.DesignA single arm mixed-methods feasibility study across two UK NHS hospitals.ProcedureEligible HNC patients (aged ≥ 16 years old, treated with curative intent and classified as low/medium risk according to an exercise risk stratification tool) were invited to participate between diagnosis and 8 weeks post-treatment. Patients treated with palliative intent and those identified as high risk on an exercise risk stratification tool were excluded. Following initial assessment, Cancer Exercise Specialists (CESs) and patients collaboratively devised a personalised exercise programme based on a needs analysis, preferences and goals, and informed by physical activity cancer guidelines and theory. CESs were trained in behaviour change techniques. The intervention was flexible and delivered remotely across 8 weeks, with weekly meetings and texts, and an exercise maintenance plan agreed in the final session.OutcomesEligibility, recruitment, retention and exercise adherence were primary outcomes. Quantitative outcomes included quality-of-life, fatigue and physical activity questionnaires and physical fitness tests. A qualitative sub-study explored patients’ and healthcare professionals’ (HCPs’) views on feasibility and acceptability.Results98% of patients screened were eligible; 107 patients were approached, and 76 consented (71%). Most (43%) were recruited pre-treatment. Three quarters were male and just over half had oropharyngeal cancer. Thirteen patients (17.1%) were withdrawn due to ill-health. Twenty-three (30.3%) patients dropped out, 13 after assessment but before the intervention, and ten during the intervention. Forty patients (52.6%) completed the intervention. Three quarters of exercise sessions were completed as prescribed. Patient interviews found the flexible, personalised approach valuable. Those not identifying as an ‘exerciser’ found the intervention more difficult to understand. The need for more education for both HCPs and patients regarding the benefits of exercise and its ‘fit’ within the HNC pathway was highlighted.ConclusionThis is a feasible and acceptable intervention, but some adjustments are required, to improve acceptability, recruitment processes, retention and adherence, before examining effectiveness in a definitive trial.Clinical Trial Registrationhttps://www.isrctn.com/ISRCTN82505455, identifier ISRCTN82505455.

BACKGROUND:International guidelines now recommend adopting individualized approaches which consider patient preferences when deciding the extent of surgical resection for low-risk differentiated thyroid carcinoma (LRDTC). Information-sharing must be methodical to help patients make informed decisions without feeling overwhelmed by information. Understanding the factors influencing decision-making is therefore essential. METHODS:Semi-structured interviews were conducted between May 2023 and June 2024 at two large tertiary referral centers in England, United Kingdom. Consecutive sampling via the multidisciplinary team meetings was used to identify patients newly diagnosed with LRDTC measuring 1-4 cm without adverse features, choosing between hemithyroidectomy and total thyroidectomy, or, if diagnosed following hemithyroidectomy, active surveillance and total thyroidectomy. Clinicians directly involved in their care were approached and recruited, with six consultant thyroid surgeons (five male, one female), and two thyroid cancer nurse specialists (both female), agreeing to participate. All had experience managing over 10 LRDTC patients annually.Transcripts were analyzed using the framework method of thematic analysis. RESULTS:Twenty-four patients were identified, and 19 agreed to participate (13 female, 6 male). Information-sharing was often perceived as a didactic process, leaving patients overwhelmed with complex clinical details. Both groups emphasized tailoring information to meet patients' needs and delivering it in bite-sized portions to enhance comprehension. Key factors influencing individual decisions included a desire among most patients to minimize the number of, and extent of, surgical procedures, the need to preserve the thyroid gland and avoid hormone supplementation, and the patient's ability to accept the cancer recurrence risk. Although autonomy was paramount for patients, providers' recommendations still significantly impacted the final decision. Some clinicians expressed concern that multiple treatment options might confuse patients, instead entrusting decision-making to the multidisciplinary team meetings. CONCLUSIONS:This study identified essential information needs for LRDTC treatment decision-making, which can help inform the development of decision-support tools. Multidisciplinary team discussions may need to evolve to allow greater flexibility and support individualized decision-making.

PURPOSE:The needs of head and neck cancer (HNC) carers tends to be poorly addressed as most support systems are directed towards patients. This systematic review synthesises the existing qualitative evidence from carers for adult HNC patients to explore their experiences and needs as a basis to inform the initial development of an item prompt list for HNC carers for use in routine clinical practice. METHODS:Seven electronic databases were searched from their inception until November 2022, supplemented by citation chaining and snowballing. Primary qualitative or mixed-methods studies reporting the experiences of carers for HNC patients, elicited using interviews, were included. Screening and selection, data extraction and quality assessment (Critical Appraisal Skills Programme Checklist) were independently conducted by two researchers. Data were analysed using inductive thematic synthesis and confidence evaluated using GRADE CERQual. RESULTS:Thirty studies met the inclusion criteria. Two overarching themes and nine subthemes emerged: (i) the experiences of loss associated with being a carer (loss of: role and everyday routine, certainty leading to emotional distress, security as fear of recurrence prevailed, finances, intimacy and togetherness, enjoyment from social activities); and (ii) factors promoting coping and adjustment to role of carer (information, supportive mechanisms, personal attributes). CONCLUSION:New insight into the experiences of HNC carers provides the basis for item generation of a HNC carer prompt tool. IMPLICATIONS FOR CANCER SURVIVORS:With such a range of potential unmet concerns, the development of a prompt list should help to elicit these and provide additional means to targeted support.

OBJECTIVE:The management of large central giant cell granuloma (CGCG) can pose a significant surgical challenge. In such circumstances, the use of denosumab has been proposed with the literature reporting varying degrees of success. Histopathological assessment of CGCG post-denosumab treatment remains unknown. The current case series aims to address this lack of information and supplement the literature and the debate with evidence. STUDY DESIGN:The current case series is a retrospective review of historic cases accumulated from 3 different hospitals. Patients treated with denosumab for large or unresectable GCGC who subsequently underwent either surgical debulk or resection post drug treatment with histological tissue for assessment were included. RESULTS:A total of 4 patients were included in this study. All cases showed radiographic response. However histological assessment identified giant cells in 3 of the 4 cases, 2 of which showed clinical recurrence. All cases demonstrated irregular woven bone formation toward the periphery of the lesion suggesting partial response. CONCLUSIONS:The current case series provides some insight regarding the response of CGCG to denosumab and preliminary histopathological information toward the ongoing debate regarding the medical management of CGCG. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Objective: Patients with head and neck cancer (HNC) report some of the highest levels of psychological distress amid managing their disease as well as debilitating and disfiguring treatment side effects. Fear of cancer recurrence (FCR) is a top unmet need and concern of patients with HNC. Prior research suggests elevated symptoms of anxiety and depression are potential antecedents to FCR, but findings have been limited in HNC populations. The aim of the present study was to examine the early level and change in symptoms of anxiety and depression in relation to later change in FCR among patients with HNC. Method: The study is a secondary analysis of data collected from 2011 to 2014 through the Head and Neck 5000 Study in the United Kingdom. A sample of 4,891 patients completed self-report longitudinal assessments of anxiety and depression symptoms at baseline, 4, and 12 months and FCR at 4 and 12 months. Results: Utilizing multiple indicator latent change score modeling, results revealed baseline anxiety and increases in anxiety from baseline to 4 months were both positively associated with increases in FCR from 4 to 12 months. Neither baseline depression nor change in depression from baseline to 4 months were significantly associated with FCR change. Conclusions: Findings indicate that early level and increases in symptoms of anxiety were markers of increased FCR in patients with HNC. Future research may consider anxiety as a unique antecedent and maintaining factor of FCR and targeting anxiety early in the cancer trajectory may have downstream effects on FCR development.

Temporomandibular disorders (TMD) are a group of common conditions that can have significant detrimental impact on patients functional, emotional and social wellbeing. The aim of this systematic review is to collate and summarise the literature reporting patients' experience of TMD. This helps put the condition into the context of the patient themselves and their interaction with healthcare professionals. The study was completed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. A systematic literature search was performed on 1 December 2023 using following databases: MEDLINE, Embase, Web of Science, PsychInfo (American Psychological Associated) and the Cochrane Library. Of these 439 articles, 13 met the inclusion criteria for the review. It was a heterogenous sample with relatively poor methodological quality. The cohorts ranged from nine to 44; totalling 280 participants. Two key themes and six subthemes illustrate the experience of patients with TMD: Impact (Physical, Psychological) and Coping (Understanding the disease, Experience of healthcare professionals, Seeking treatment, Adapting behaviours). Clinical care needs to reflect the experience of patients with better explanation of the condition, access to services and support. Further research should explore how to address patients' concerns more effectively. One method might be through the development of a PCI-TMD.

In the elderly population there is increasing evidence that frailty predicts adverse outcomes better than chronological age. Sarcopenia is an important component of frailty. This study aimed to establish the relevance of sarcopenia in elderly patients with oral squamous cell carcinoma (OSCC) undergoing surgery. This retrospective, single-centre, cohort study included patients over the age of 75 years who were diagnosed with OSCC between 2007 and 2016. Cross-sectional imaging of the neck was used to predict the Skeletal Muscle Index (SMI) using validated equations. Based on established thresholds, patients were categorised as having either a normal or low SMI, indicative of sarcopenia. Sixty-nine patients met the inclusion criteria. Patients with a low SMI had a longer length of stay (16.9 days vs 9.8 days, p = 0.030); they had more severe complications, defined as Clavien-Dindo grade IIIb or higher (17.6% vs 4.0%, p = 0.042); and their mean Comprehensive Complication Index (CCI) was also higher (14.1 vs 4.7, p = 0.051). Furthermore, 2/34 patients in the low SMI group died within 30 days of surgery compared with none in the normal SMI group (5.9% vs 0%, p = 0.503). Whilst patients with a low SMI who underwent surgery had lower five-year overall survival, the difference was not statistically significant. This study shows that sarcopenia negatively influences surgical outcomes in elderly patients. Routine measurement of SMI could be an indication for a comprehensive geriatric assessment (CGA).

The Patient Concerns Inventory (PCI) allows patients to highlight the issues they would like to discuss at their out-patient consultation. It improves patient-clinician communication and has proven benefits. While the PCI is effective, patient experiences could be improved with better access to it and the ability to more easily and frequently express their concerns. This, of course, is in the context of ever increasing healthcare challenges and limited resources. Use of Conversational Artificial Intelligence (CAI) represents an opportunity to improve information flow between patients and professionals remote from the consultation. This paper highlights the potential for CAI to provide an ‘always-on’ platform, using natural language interface technology and based on the PCI, which patients can access via their mobile devices. We also discuss potential pitfalls and concerns, along with outlining a current clinical trial assessing, in the first instance, usability of this technology.

Purpose/Objective Physical exercise is a safe, cost-efficient, and effective intervention for cancer survivors. Regular exercise can reduce symptoms such as cancer-related fatigue, depression, prevent and reduce co-morbidities, attenuate toxicity related to cancer treatment, and reduce cancer-specific and all-cause mortality 1-4. Exercise is generally recommended for all cancer survivors and should be started as early as possible 5. However, there is limited evidence in head and neck cancer (HNC) 6, which has multiple challenges; patients typically present with substantial weight loss, inactivity and low cardiorespiratory fitness; treatments are gruelling with substantial short and long-term symptom burden; many live in areas of high deprivation, residing some distance from their treating centre and have low levels of health literacy; integrating interventions to this complex care pathway is challenging 7-13.Objective: To investigate the feasibility of introducing a remotely delivered, personalised, collaborative, and flexible exercise programme into the HNC care pathway. Material/Methods This prospective single arm feasibility and acceptability study aimed to recruit seventy HNC patients from two UK Centres, over 12 months. A conservative retention rate of 60% was predicted, to provide a minimum of 42 patients on study completion. The intervention was a personalised 8-week exercise programme delivered remotely by cancer exercise specialists, trained in behaviour change techniques. Patients were invited to participate any time between diagnosis and 8 weeks post-treatment, according to their preference. Intervention content was based on patient needs, preferences, and goals, guided by physical activity cancer guidelines. Primary outcomes included recruitment and retention. A qualitative sub-study included patient and healthcare professionals semi-structured interviews to evaluate intervention experiences and processes. Results One hundred and eighteen patients were eligible for the study, 107 patients were approached, and 76 consented (71%). Recruitment uptake was different for each site 54% vs 82%. Reasons for non-participation were; too much to think about, additional paperwork, uninterested in exercise.Participants M:F ratio 3:1; mean age 60.5 years (range 34-80). The majority had oropharyngeal (54%) or oral cancer (33%), 56% had T1/2 tumours. Fifteen patients (19%) had over the recommended alcohol intake (14 units/week), 8 (10.5%) were current smokers. Treatment included surgery alone (28.8%) surgery and adjuvant (chemo)radiotherapy (50.0%) or primary (chemo)radiotherapy (21.2%). The majority of patients consented to ACTIOHN pre-treatment (45%). Data collection finishes in February 2024. To date, 32 patients have completed ACTIOHN, 27 are on treatment and 17 have withdrawn. Key themes from on-going patient interviews (N=17) are; therapeutic alliances; understanding what the intervention involved; personalisation; treatment impact; programme impact; paperwork, and from eight healthcare professionals; describing the programme; personalisation; nutrition; treatment impact; buy-in. Conclusion This high uptake indicates that the ACTIOHN intervention was acceptable to HNC patients. Overall patients and HCPs were positive about the intervention. However, there were substantial system challenges, and despite many consenting to participate pre-treatment, a proportion of surgical patients were unable to start ACTIOHN until post-treatment. Patients appreciated a strong therapeutic bond and tailoring of the intervention to their needs and preferences. ACTIOHN requires further investigation to test effectiveness and fit with the pathway.

PURPOSE:Physical activity (PA) can improve health-related outcomes for head and neck cancer (HaNC) patients, and PA guidance from healthcare professionals' can increase patients' PA levels. However, less than 9% of HaNC patients are physically active. This study explored healthcare professionals' promotion of PA across the National Health Service (NHS) in North West England and North Wales, to HaNC patients. METHODS:A cross-sectional online survey exploring healthcare professionals' promotion of PA in HaNC. The International Physical Activity Questionnaire-Short Form was used to estimate healthcare professionals' PA levels. Quantitative data were analyzed using descriptive or inferential statistics and qualitative data were analyzed using reflexive thematic analysis. Data were synthesized drawing on the capability-opportunity-motivation-behavior model and theoretical domains framework. RESULTS:Eighty-one professionals participated. Fifty-three percent self-reported high levels of PA. Seventy-five percent considered PA promotion as part of their role; however, only 39% discussed PA with their patients (reflective motivation and social/professional role and identity). Only 38% felt confident initiating PA discussions and 76% reported needing further training. Training on the benefits of PA for HaNC patients and how to encourage health-related behavior change were identified as beneficial (psychological capability and knowledge). CONCLUSION:Healthcare professionals are influential in enabling patients to adopt health-related behavior change; however, PA promotion was not routine practice for professionals involved in the care of HaNC patients. Training should be provided to professionals on PA promotion, with a focus on behavior change techniques. Future research should explore how behavior change techniques can be implemented into clinical practice to improve health-related outcomes in HaNC.