Too Frail for Cancer Surgery

Skin cancer surgery not always beneficial for people with limited life expectancies

(RxWiki News) You have a one in five chance of getting skin cancer at some point in your life. We all do. How elderly skin cancer patients are treated is now being called into question.

Frail and sick elderly patients may not live long enough to benefit from skin cancer treatment, according to a new study.

Results of this study showed that these older patients were more likely than younger folks to suffer from treatment complications.

"Wear a hat when you’re in the sun."

Researchers from around the country looked at how elderly patients with limited life expectancy are treated for non-melanoma skin cancer (NMSC).

The research was led by Eleni Linos, MD, DrPH, an assistant professor of dermatology at the University of California, San Francisco (UCSF).

“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 [have no symptoms],” Dr. Linos said in a press release announcing the study results.

Skin cancers are diagnosed in more than 2 million Americans every year. The two most common forms of NMSC are basal cell carcinoma and squamous cell carcinoma, neither of which is normally life-threatening.

Most of these skin cancers are treated with surgery to remove the tumors. That’s the standard of care.

The authors pointed out in their paper that “…no guidelines exist about whether physicians should consider patient age or functional status in choosing treatments.”

These researchers followed more than 1,300 patients with NMSC in San Francisco for about a decade.

About one-quarter of these patients were said to have limited life expectancy because they were either 85 years old or older or had a number of serious health conditions.

Despite their age and other health conditions, most of the 1,300 patients underwent surgery to treat the skin cancer.

This procedure can be difficult for older patients, and 20 percent reported medical complications—including numbness, itching, pain or poor wound healing—within two years of the surgery.

Skin cancer tumors recurred (returned) in only 4 percent of patients. About half of the patients died within five years of being diagnosed, but none died because of skin cancer.

“Given the very low tumor recurrence rates and high mortality from causes unrelated to NMSC in patients with limited life expectancy, clinicians should consider whether these patients would prefer less invasive treatment strategies,” the authors wrote.

“The findings suggest that many patients may not live long enough to benefit from treatment of NMSC but are at risk for treatment-related complications,” the authors concluded.

This study was published April 29 in JAMA-Internal Medicine.

The research was supported by the National Center for Research Resources, the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health and by a Career Development Award from the American Skin Association and Dermatology Foundation.

One of the authors disclosed a paid consultancy with Genentech. No other conflicts of interest were reported.

Review Date: 
April 30, 2013