Aggressive Surgery for Nonfatal Skin Cancers Might Not Be Best for All Elderly Patients
New UCSF Study Urges Doctors to Consider Patient Risks, Benefits and Preferences When Treating Low-Risk Skin Cancers
By Elizabeth Fernandez | UCSF.edu | April 29, 2013
Surgery is often recommended for skin cancers, but older, sicker patients can endure complications as a result and may not live long enough to benefit from the treatment.
A new study led by UC San Francisco focused on the vexing problem of how best to handle non-melanoma skin cancers – which are very common -- among frail, elderly patients. In the study sample, the researchers found that most non-melanoma skin cancers were typically treated surgically, regardless of the patient’s life expectancy or whether the tumor was likely to recur or harm the patient.
One in five patients in the study reported a complication from the skin cancer treatment, and approximately half the patients with limited life expectancy died of other causes within five years.
As a result, the authors say, doctors should take into consideration the benefits, risk and preference of a patient when determining appropriate treatment for nonfatal skin cancers.
The study will be published online on April 29, 2013 in JAMA Internal Medicine.
"It can be very challenging to decide whether and how to treat patients with non-melanoma skin cancer who have limited life expectancy, especially when the tumors are asymptomatic," said Eleni Linos, MD, DrPH, an assistant professor of dermatology at UCSF and lead author of the study.
"One challenge is that it is hard to precisely predict an individual’s life expectancy," Linos noted. "Another challenge is that elderly patients are very diverse. For example, some 90-year-olds are active, healthy and would like to choose the most aggressive treatments for skin cancer, while others are very frail and unable to care for themselves, and may prefer less invasive management for a skin cancer that doesn’t bother them.
"Bothersome or medically dangerous skin tumors should always be treated, regardless of age or life expectancy," Linos said. "But treatment of asymptomatic tumors might not be the best option for all patients."
Non-Melanoma Skin Cancer in Older Patients
Skin cancers are by far the most common type of cancer, according to the American Cancer Society. An estimated 2.2 million Americans – predominantly older patients -- are diagnosed annually with a non-melanoma skin cancer, including basal cell carcinoma and squamous cell carcinoma. This type of cancer can be slow-growing and typically does not affect survival or short-term quality of life.