The Effect of Music on Intraoperative Anxiety During Dermatologic Surgery: A Randomized Controlled Trial Comparing Rock and Classical Genres

<b><i>Background:</i></b> Music has been widely investigated as a non-pharmacological tool to reduce perioperative anxiety, yet its role in dermatologic surgery remains underexplored. This study aimed to evaluate the effect of different music genres on perioperative anxiety during awake dermosurgical procedures. <b><i>Methods</i><i>:</i></b> We conducted a prospective, randomized, single-blind controlled trial at the San Gallicano Dermatological Institute IRCCS between March and December 2021. A total of 232 adult patients undergoing excision of atypical skin lesions were randomly assigned to three groups: rock music, classical music, or silence (control). Standardized playlists were played via speakers during surgery. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI-Y1) at baseline (T0), immediately post-procedure (T1), and 48 h later (T2). Psychological profiles were further evaluated with the DASS-21 and patient-reported measures. <b><i>Results</i><i>:</i></b> All groups showed a significant reduction in anxiety from T0 to T1 (<i>p</i> < 0.001). While between-group differences at T1 and T2 were not statistically significant, the greatest mean percentage reduction in anxiety was observed in the rock group (-16.8% ± 19.8), followed by classical (-15.7% ± 23.3) and silence (-11.6% ± 18.3). Patient satisfaction was highest in the rock group (9.3 ± 1.4; <i>p</i> = 0.015). Baseline psychological distress was higher among first-time surgical patients, especially in the rock group. <b><i>Conclusions</i><i>:</i></b> Music, particularly rock, appears to be an effective adjunct to reduce anxiety and improve patient experience during awake dermatologic surgery. These findings support the integration of music into routine dermosurgical care.