Abstract A104: Neglecting the obvious: A retrospective chart review analyzing the sociodemographic and psychiatric factors associated with large cutaneous tumors (LCTs) at an academic medical center
Authors: Negbenebor Nicole A. , Bravo Carolina Gonzalez , Sidey Kirk , Cusick Elizabeth , Beek Marta Hemmingson-Van 
Published: December 2023

Abstract
Purpose: Current understanding of factors associated with the progression and possible delay of presentation of large cutaneous tumors (LCTs) of the head and neck is widely unknown. Treatment is challenging, often requiring a multidisciplinary team, and is costly to our healthcare system. Previously published studies have concluded that the major contributing cause of LCTs is psychiatric and the result of tumor “neglect.” However, there are no set criteria delineating “neglect.” Additionally, with the increase in dermatologic wait times, there are no studies exploring the role that access to the healthcare system plays in the progression of LCTs. The purpose of our study is to (1) identify the characteristics and associations between sociodemographic and psychiatric variables among patients with LCTs and (2) analyze healthcare system factors correlating with the progression of these tumors. Summary: We characterize the role sociodemographic and psychiatric variables play among patients with LCTs. Previous publications suggest that LCTs are the product of tumor neglect—a maladaptive coping mechanism where the patient will deny the presence of an obvious, growing tumor with early signs of malignancy. The causes of tumor “neglect” are often cited as psychiatric, but this is neither well understood nor defined. The existing literature fails to consider sociodemographic variables, documented history of psychiatric disorders, and the role of hospital system challenges that contribute to the unusual presentation of LCTs. Our cohort had no history of any psychiatric condition. Patients had an average of six co-morbidities and a mean age of 79. Important healthcare system factors identified were delays in time from consultation from the outside referring provider to day of Mohs procedure, distance from the academic medical center, and type of medical insurance. Design: We conducted a retrospective cohort study based on linked electronic health records (EHRs) data from one academic medical center. TriNetX was used for the selection of our patient cohort from 05/11/2022 – 11/11/2022. We identified 14 adult patients in our database that underwent Mohs surgery for cutaneous BCC or SCC during a six-month period with a resulting surgical defect of ≥5.0 cm and preoperative size of ≥4.0 cm. These metrics were chosen based on the Brigham and Women's Hospital (BWH) and American Joint Committee on Cancer (AJCC) tumor classification system for BCC and SCC which defines highest-risk cancers as ≥4.0 cm. Conclusion: To our knowledge, this is the first retrospective study to evaluate factors related to LCTs at an academic institution. Contradictory to previous literature, we found no correlation to psychiatric disease among LCTs. Persistent post-pandemic health system challenges in staffing and access to coordinating oncologic OR services contributed to delays in care. Innovative approaches to health care delivery may be indicated to avert further delays contributing to LCTs.
Citation Format: Nicole A. Negbenebor, Carolina Gonzalez Bravo, Kirk Sidey, Elizabeth Cusick, Marta Hemmingson-Van Beek. Neglecting the obvious: A retrospective chart review analyzing the sociodemographic and psychiatric factors associated with large cutaneous tumors (LCTs) at an academic medical center [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A104.