Physical Attractiveness and Clinical Decision-Making in Non-Melanoma Head and Neck Skin Cancer: A Cross-Sectional Survey Study

Objective: To evaluate the effect of facial attractiveness on treatment recommendations for non-melanoma skin cancer of the head and neck. Methods: We conducted a cross-sectional survey of Canadian surgeons and radiation oncologists to assess the effect of facial attractiveness on treatment choices for non-melanoma head and neck skin cancers. Participants rated preference of surgery or radiotherapy (RT) for digitally altered images with lesions at 5 facial subsites. The primary outcome was the association between attractiveness and treatment choice; the secondary outcome was the influence of lesion location. Associations between attractiveness and treatment choice were analyzed with Spearman’s correlation, and site-specific differences were descriptively evaluated. Results: One hundred and eight respondents (17.8% response rate) completed the survey. Surgery was favored across all anatomical subsites. Facial attractiveness was not significantly associated with treatment recommendations at any subsite. At the nasal tip, there was a trend toward recommending surgery for more attractive patients (ρ = 0.13, P = .08). Independent of attractiveness, lesion location appeared to influence treatment recommendations, with the nasal tip more often considered for RT than other subsites. Conclusions: Facial attractiveness did not influence treatment recommendations for non-melanoma head and neck skin cancers. Surgery was preferred across anatomic subsites, but respondents often considered for RT for treating nasal tip non-melanoma skin cancers.