September 23, 2019
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Elderly patients with nonmelanoma skin cancer more likely to go untreated

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Patients with nonmelanoma skin cancer aged 85 years or older had significantly higher odds of being untreated, according to an analysis.

“To our knowledge, this is the first retrospective study comparing clinical characteristics between treated and untreated elderly with [nonmelanoma skin cancer],” Martina L. Porter, MD, of the department of dermatology at Beth Israel Deaconess Medical Center, Boston, and colleagues wrote. “Univariate characteristics associated with untreated [nonmelanoma skin cancer] in the elderly at our institution include female sex, no prior skin cancer, high comorbidity burden, and neurologic or functional impairments.”

In 927 biopsy-proven nonmelanoma skin cancers, Mohs micrographic surgery was the most common treatment. Between elderly patients, defined as 85 years or older, and non-elderly patients, the difference in rates of untreated skin cancer cases was significant (13% vs 4.2%, X2 < .0001). Patients aged 85 years or older had significantly higher univariate odds of being untreated (OR = 3.62, P = .018).

The most common reason for not undergoing treatment was loss to follow-up (35%), followed by negative biopsy margins (23%), refusal due to age or comorbidities (21%) and management at outside hospital (10%), according to the researchers.

Women were more likely to go untreated in the elderly age group (OR = 7.43, P = 0.12).

Going untreated was more likely in those with neurocognitive impairment, impairment in activities of daily living and hemiplegia. Treatment was more likely in patients with a prior skin cancer (OR = 0.10, P = .001).

Study limitations include the retrospective single-center design, small sample size and the lack of data on non-biopsied suspected skin cancers. – by Abigail Sutton

 

Disclosures: The authors report no relevant financial disclosures.