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Do skin cancers on elderly patients always need to be treated?
In very elderly patients, less aggressive skin cancers on the faces might not always need to be treated, according to a study in the US. Research suggests that the age and relative lifespan of the patient should be taken into consideration when deliberating treatment for slow-growing non-melanoma skin cancer on the face.
In a study published in JAMA Surgery, researchers said that there are multiple ways to treat non-melanoma skin cancers such as basal cell carcinoma and squamous cell carcinoma, and that the decision to treat them should take into account the patient’s lifestyle, needs and wishes. Researchers also advised that patients need to understand what the course of the cancer usually is.
The findings were based on a study of 440 adults aged over 40, with 569 non-melanoma skin cancers on the face. About 55 percent of the tumours were basal cell carcinomas and 30 percent were squamous cell carcinomas.
In a third of patients aged over 80 – and in half of those aged over 90 – there was no cancer left in the skin after the lesion was removed for biopsy. Researchers said that most patients did not need more extensive treatments after biopsy.
Over several years, 50 patients died. The largest percentage of deaths was among patients in their 90s, but no one died of the skin cancers.
More than half of the patients who were in their 90s died within a year. Researchers said that the small skin cancers would never have caused a problem for these patients, and that a strong argument can be made for a “watchful-waiting approach for the amenable nonagenarian”.
In Australia, around $500million is spent every year to treat skin cancers – much of it in elderly patients. Many non-melanoma skin cancers are not expected to progress far enough to cause death in patients whose lifespans are already limited.
However, researchers said the data are not definitive enough to change the standard of care and simply monitor elderly patients without formal treatment. Further studies are needed to investigate if a watchful-waiting approach is cost-effective and leads to higher patient satisfaction than surgical excision in the ageing population.
Chauhan R, Munger BN, Chu MW, Munshi I, Cohen AC, Wooden WA, Tholpady SS. Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer. JAMA Surgery. Published online December 20, 2017. doi:10.1001/jamasurg.2017.5073
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