Abstract
Purpose of Review
We seek to explain how the treatment of non-melanoma skin cancer (NMSC) should differ in certain geriatric patients. Our goal is to provide primary care physicians with a comprehensive methodology for approaching the evaluation and management of these patients.
Recent Findings
Recent retrospective studies have revealed that the rates of aggressive surgical treatment of NMSCs are equivalent in non-age restricted and geriatric populations, including those with limited life expectancy. Geriatric patients have higher rates of post-operative complications without affecting disease specific survival. These studies suggest that we must carefully consider how we counsel and treat elderly patients with NMSC.
Summary
There are many surgical and non-surgical treatment modalities for NMSC that offer varying cure rates. Given the non-lethal nature of many of these tumors, active surveillance is another viable treatment alternative especially in patients with limited life expectancy. Ultimately, we must engage in shared decision-making with our patients to develop treatment plans that best align with each patient’s overall goals of care.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
• Garvcovich S, et al. Skin cancer epidemics in the elderly as a n emerging issue in geriatric oncology. Aging Dis. 2017;8(5):643–61 This review article highlights the increasing epidemic of NMSC in the elderly in terms of incidence and financial burden.
Leiter U, Keim U, Eigentler T, et al. Incidence mortality, and trends of nonmelanoma skin cancer in Germany. J Investig Dermatol. 2017;137(9):1860–76.
Werner RN, et al. The natural history of actinic keratosis: a systematic review. Br J Dermatol. 2013;169(3):502–16.
NCCN Guidelines: Basal cell carcinoma. 2016.
NCCN Guidelines: Squamous cell carcinoma. 2016.
Purnell JC et. al. Conventional versus giant basal cell carcinoma, a review of 57 cases: Histologic differences contributing to excessive growth. Indian J Dermatol 2018: 63(2): 147–154.
Rieger KE, et al. Recurrence rates associated with incompletely excised low-risk nonmelanoma skin cancer. J Cutan Pathol. 2010;37:59–67.
Swetter SM et. al. Effects of biopsy-induced wound healing on residual basal cell and squamous cell carcinomas: rate of tumor regression in excisional specimens. J Cutan Pathol 2003: 30: 139–146.
• Bouhassira J et. al. Factors associated with postoperative complications in elderly patients with skin cancer: a retrospective study of 241 patients. J Geriatr Onc 2016: 10–14. Single-center retrospective study that evaluated the post -operative complication rate of patients older than 75 undergoing treatment of their NMSC.
Linos E, VanBeek M, Resneck JS. A sudden and concerning increase in the use of electronic brachytherapy for skin cancer. JAMA Dermatol. 2015;151(7):699–700.
• Chauhan R et. al. Age at diagnosis as a relative contraindication for intervention in facial nonmelanoma skin cancer. JAMA Surgery 2018: E1-E2. Single-center retrospective study that revealed that disease specific survival was not affected by excision of small facial NMSC.
Feng H, Belkin D, Geronemus RG. Geographic distribution of U.S. Mohs micrographic surgery workforce. Dermatol Surg. 2018, 1.
Linos E, Berger T, Chren M. Point: care of potential low-risk basal cell carcinoma at the end of life. J Am Acad Dermatol. 2015;73(1):151–61.
Lee et. al. Comorbidity assessment in skin cancer patients: a pilot study comparing medical interview with a patient-reported questionnaire. J of Skin Cancer 2015: 1–6.
Rogers EM, Connolly KL, Nehal KS, et al. Comorbidity scores associated with limited life expectancy in the very elderly with nonmelanoma skin cancer. JAAD. 2018;78(6):1119–24.
Linos E, et al. Treatment of nonfatal conditions at the end of life: nonmelanoma skin cancer. JAMA Intern Med. 2013;173(11):1006–12.
• Linos E, Chren MM, Covinsky K. Geriatric dermatology- a framework for caring for older patients with skin disease. JAMA Dermatol. 2018: E1-E2. Editorial on geriatric dermatology that highlights the importance of considering unique patient characteristics when evaluating elderly patients and advocates for explicitly incorporating geriatrics into dermatology in a manner similar to pediatrics in dermatology.
• Linos E et. al. Skin cancer in US elders: does life expectancy play a role in treatment decisions? J Am Geratr Soc 2016: 64(8): 1610-1615. This retrospective study analyzed the treatment modality used to treat NMSC in over 9500 older than age 65. It revealed that most NMSC were treated surgically.
• Jung J, Linos E. Adding active surveillance as a treatment option for low risk skin cancers in patients with limited life expectancy. J of Geriatr Onc. 2016;7:221–2. Editorial on why the concept of watchful waiting is so difficult for clinicians and postulates that while fear of litigation is partly responsible, the true driving factor is a concern about not giving our patients the “gold standard”.
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Alexandra Zeitany and Adewole Adamson declare no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Dermatology and Wound Care
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Zeitany, A., Adamson, A. Treatment of Non-melanoma Skin Cancer in the Elderly. Curr Geri Rep 7, 216–221 (2018). https://doi.org/10.1007/s13670-018-0264-y
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DOI: https://doi.org/10.1007/s13670-018-0264-y