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

2022; American Medical Association; Volume: 158; Issue: 7 Linguagem: Inglês

10.1001/jamadermatol.2022.1733

2168-6084

Amanda Maisel-Campbell, Katherine A. Lin, Sarah A. Ibrahim, Bianca Y. Kang, Noor Anvery, McKenzie A. Dirr, Rachel E. Christensen, Juliet L. Aylward, Omar Bari, Hamza Bhatti, Diana Bolotin, Basil S. Cherpelis, Joel L. Cohen, Sean Condon, Sheila Farhang, Bahar F. Firoz, Algin B. Garrett, Roy G. Geronemus, Nicholas Golda, Tatyana R. Humphreys, Eva A. Hurst, Oren H. Jacobson, Shang Jiang, Pritesh S. Karia, Arash Kimyai‐Asadi, David J. Kouba, James G. Lahti, M. Laurin Council, Marilyn Le, Deborah F. MacFarlane, Ian A. Maher, Stanley J. Miller, Eduardo K. Moioli, Meghan Morrow, Julia P. Neckman, T. J. Pearson, Samuel R. Peterson, Christine Poblete-Lopez, Chad L. Prather, Jennifer S Ranario, Ashley G. Rubin, Chrysalyne D. Schmults, Andrew M. Swanson, Christopher Urban, Yaohui G. Xu, Murad Alam, Simon Yoo, Emily Poon, Vishnu Harikumar, Alexandra Weil, Sanjana Iyengar, Matthew Schaeffer,

Cutaneous lymphoproliferative disorders research

Importance It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs. Objective To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals. Design, Setting, and Participants This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019. Exposures Mohs surgery for nonmelanoma skin cancer. Main Outcomes and Measures Reason for treatment selection. Results Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]). Conclusions and Relevance This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.