Surgical Treatment of Nonmelanoma Skin Cancer in Older Adult Veterans

Abstract

Background: Older adult patients are frequently referred to surgical services for the treatment of nonmelanoma skin cancer (NMSC). The appropriateness of offering surgery to patients with serious comorbidities and a limited life expectancy has been questioned in the literature. The purpose of this study was to determine the morbidity and 5-year mortality for patients with NMSC referred to the plastic surgery service. Methods: A retrospective chart review was performed from July 1, 2011, to June 30, 2015, of all plastic surgery service consults for the treatment of NMSC. We collected the following data: age and life-limiting comorbidities at the time of referral, treatment, complications, and 5-year mortality. A χ 2 analysis was used to determine the statistical significance (P < .05) between the individual risk factors and 5-year mortality. The relative risk of 5-year mortality was calculated combining advanced age with individual comorbidities. Results: The plastic surgery service completed 800 consults for NMSC over a 4-year period. Five-year mortality was 28.6%. Median age of patients deceased at 5 years was 78 years at the time of the consult submission. The surgical complication rate was 5%. Aged ≥ 80 years, coronary artery disease, congestive heart failure, cerebral vascular disease, peripheral vascular disease, dementia, chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus were found individually to be statistically significant predictors of 5-year mortality. Combining aged ≥ 80 years, coronary artery disease, congestive heart failure, or dementia increased the 5-year mortality to a relative risk > 3. Conclusions: Surgical excision of NMSC in older adult patients is indicated in most situations. A frank discussion with the patient and caregiver is suggested. Surgical treatment of NMSC in older adult patients has a low morbidity but needs to be balanced against a patient's quality of life when they present with life-limiting comorbidities.

Patient-Orientated Evaluation of Treatment of Non-Melanoma Skin Cancer with Rhenium-188 Compared to Surgery

“…The patients in our cohort who would choose RSCT as the first line treatment if a new NMSC occurred were in a median of 85 years of age. The incidence of NMSCs increases with age and is commonly found in nursing homes and geriatric units [27]. Mohs micrographic surgery entails multiple time-consuming surgical and histological examinations for each patient and may lead to longer hospitalization.…”

“…It has therefore been questioned in the literature whether to treat asymptomatic NMSC at all since it will probably not affect a patient's life expectancy. However, since untreated NMSC may cause local destruction and disfigurement and old patients may live to be even older, it has been agreed that surgical excision of NMSC in older adult patients is indicated in most situations [27]. Older patients with NMSC, in particular, may benefit from a tailored treatment plan based on current available data for NMSC [28].…”