Amanda Maisel-Campbell1,2, Katherine A Lin1, Sarah A Ibrahim1, Bianca Y Kang1, Noor Anvery1, McKenzie A Dirr1, Rachel E Christensen1, Juliet L Aylward3, Omar Bari4,5, Hamza Bhatti6,7, Diana Bolotin8, Basil S Cherpelis9, Joel L Cohen10,11, Sean Condon12,13, Sheila Farhang9,14, Bahar Firoz6, Algin B Garrett15, Roy G Geronemus16,17, Nicholas J Golda18, Tatyana R Humphreys19,20, Eva A Hurst21,22, Oren H Jacobson23,24, S Brian Jiang4, Pritesh S Karia25, Arash Kimyai-Asadi26, David J Kouba27,28, James G Lahti29, Martha Laurin Council21, Marilyn Le19, Deborah F MacFarlane30, Ian A Maher31,32, Stanley J Miller33, Eduardo K Moioli8, Meghan Morrow1, Julia Neckman17,34, Timothy Pearson12,35, Samuel R Peterson23,36, Christine Poblete-Lopez12, Chad L Prather37, Jennifer S Ranario30,38, Ashley G Rubin4,39, Chrysalyne D Schmults25, Andrew M Swanson3, Christopher Urban21,40, Y Gloria Xu3, Murad Alam1, Simon Yoo1, Emily Poon1, Vishnu Harikumar1, Alexandra Weil1, Sanjana Iyengar1,41, Matthew R Schaeffer1,42. 1. Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois. 2. Department of Dermatology, Columbia University Medical Center, New York, New York. 3. Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison. 4. Mohs and Dermatologic Surgery Center, University of California, San Diego. 5. Division of Dermatology, University of California, Los Angeles. 6. Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey. 7. The Skin Institute of South Florida, Coral Springs. 8. Section of Dermatology, University of Chicago, Chicago, Illinois. 9. Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa. 10. AboutSkin Dermatology, Denver, Colorado. 11. Department of Dermatology, University of California Irvine. 12. Department of Dermatology, Cleveland Clinic, Cleveland, Ohio. 13. The Center For Dermatology Care, Thousand Oaks, California. 14. Avant Dermatology and Aesthetics, Tucson, Arizona. 15. Hunter Holmes McGuire VA Medical Center, Richmond, Virginia. 16. Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York. 17. Laser and Skin Surgery Center of New York, New York, New York. 18. Department of Dermatology, University of Missouri School of Medicine, Columbia. 19. Main Line Center for Skin Surgery, Bala Cynwyd, Pennsylvania. 20. Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania. 21. Division of Dermatology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri. 22. Distinctive Dermatology, Fairview Heights, Illinois. 23. Revere Health Central Utah Mohs, Provo. 24. St George's University School of Medicine, Grenada, West Indies. 25. Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 26. DermSurgery Associates, Houston, Texas. 27. Wayne State University School of Medicine, Detroit, Michigan. 28. Toledo Clinic Facial Plastics and Dermatology, Toledo, Ohio. 29. Dermatology Partners of North Shore, Northbrook, Illinois. 30. Department of Dermatology, MD Anderson Cancer Center, Houston, Texas. 31. Department of Dermatology, St Louis University, St Louis, Missouri. 32. Department of Dermatology, University of Minnesota, Minneapolis. 33. Towson, Maryland. 34. Metroderm, Atlanta, Georgia. 35. Anne Arundel Dermatology, Berlin, Maryland. 36. ERderm, Newport Beach, California. 37. Dermasurgery Center, Baton Rouge, Louisiana. 38. US Dermatology Partners, Austin, Texas. 39. Bernardo Dermatology Medical Group, Poway, California. 40. Carolina Mountain Dermatology, Arden, North Carolina. 41. Department of Dermatology, West Virginia University, Morgantown. 42. Department of Surgery, Wright State University, Boonshoft School of Medicine, Dayton, Ohio.
Abstract
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.
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.
Authors: C Camarero-Mulas; Y Delgado Jiménez; O Sanmartín-Jiménez; J R Garcés; M A Rodríguez-Prieto; T Alonso-Alonso; R Miñano Medrano; J L López-Estebaranz; E de Eusebio Murillo; P Redondo; C Ciudad-Blanco; A Toll-Abelló; J L Artola Igarza; I Allende Markixana; R Suarez Fernández; A Alfaro Rubio; M L Alonso Pacheco; H Vázquez-Veiga; P de la Cueva Dobao; V Ruiz-Salas; E Vilarrasa Rull; L Barchino; V Morales-Gordillo; I Ocerin-Guerra; R Navarro Tejedor; L Hueso; M Mayor Arenal; M J Seoane-Pose; N Cano-Martinez; I Garcia-Doval; M A Descalzo Journal: J Eur Acad Dermatol Venereol Date: 2017-10-05 Impact factor: 6.166
Authors: John Y S Kim; Jeffrey H Kozlow; Bharat Mittal; Jeffrey Moyer; Thomas Olenecki; Phillip Rodgers Journal: J Am Acad Dermatol Date: 2018-01-10 Impact factor: 11.527
Authors: Nicola A Quatrano; Euphemia W Mu; David E Orbuch; Adele Haimovic; Roy G Geronemus; Jeremy A Brauer Journal: J Drugs Dermatol Date: 2018-05-01 Impact factor: 2.114
Authors: Emma M Rogers; Karen L Connolly; Kishwer S Nehal; Stephen W Dusza; Anthony M Rossi; Erica Lee Journal: J Am Acad Dermatol Date: 2017-12-27 Impact factor: 11.527