Step V—Testing of the prefinal version

Testing the prefinal version was the final stage of the adaptation process. This pilot cross-sectional prospective study included 40 patients with cervicofacial NMSC. Once demographic and clinical data were collected, the prefinal version of the SCI adaptation (test) was applied. After 1 week, the prefinal version of the SCI (retest) was applied again. This stage was important to assess whether the meaning and answers confirmed that the adapted version retained the measurement properties required to fulfill its purpose–that is, its equivalence in the intended application.

The second stage was a cross-sectional study for clinical validation using a sample of 182 patients with cervicofacial NMSC treated in public hospitals (University Hospital [Hospital Universitário], Federal University of Sergipe [Universidade Federal de Sergipe], São Cristóvão and Lagarto campus, and Oncology Center [Centro de Oncologia]), the Emergency Hospital of Sergipe (Hospital de Urgência de Sergipe), and a private clinic in Sergipe, Brazil.

Patients were recruited during their first visit, during which they were examined by a plastic surgeon. The study inclusion criteria were as follows: patients from Brazil, older than 18 years, with a diagnosis of cervicofacial NMSC and a therapeutic plan for surgical resection of the lesion, whose cognitive conditions and verbal expressions enabled them to participate when the assessment instruments were applied, and who agreed to participate in the study voluntarily. Patients with neuropsychiatric disorders that prevented them from understanding and completing the questionnaire were excluded.

After consenting to participate in the study by completing an informed consent form (Termo de Consentimento Livre e Esclarecido), the patients were interviewed in the preoperative period (T0), when the demographic data were first collected. The data included address, place of birth, age, ethnicity, religion, marital status, education, profession, and family income. The clinical variables included the type, duration, number, size, and location of the lesions as well as symptoms associated with the lesions, prior surgeries for other lesions, H-zone involvement, functional involvement, first intervention or reoperation, margin expansion or lesion recurrence, and diagnostic hypothesis and therapeutic plan (primary wound closure, grafts, or flaps).

Once demographic and clinical data were collected, the final version of the SCI adaptation (T0) was applied. The patients underwent surgery, and their diagnosis of NMSC was confirmed with an anatomopathological examination. The final version of the SCI was applied in the postoperative period (T1) 4 months after the surgery.

Because the authors participated in the data collection, they had access to information that could identify individual participants during and after the data collection.