Assessment of Functionality in Elderly Patients When Determining Appropriate Treatment for Nonmelanoma Skin Cancers

Abstract

BACKGROUND The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.

Reconstruction of a Full-Thickness Defect Involving Nasal Tip, Bilateral Nasal Ala, and Alar Rim With Complete Loss of Cartilage

“…Treatment for nonmelanoma skin cancer (in particular basal cell carcinoma) in the elderly carries considerable controversy and functional needs must be assessed for each patient. 2 Although this tumor was unlikely to affect our patient's mortality, it was causing significant morbidity and agitation. We opted to perform as simple and as functional of a repair with the fewest trips to the surgical suite.…”

Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery

“…6 Fortunately, a study on patients older than age 75 years, and even older than age 85 years, 7 found that patients who were more functional were more likely to receive surgery. Another study 8 found that patients who were less functional were more likely to undergo other treatment types, even when they met appropriate use criteria for Mohs surgery. Among older patients, Mohs surgery is associated with an improvement in survival of almost 2 years vs similar cohorts who received other treatments.…”