In elderly patients, less aggressive skin cancers on the face may not generally need to be treated, a new study proposes. Age of the patient and relative lifespan could be taken into consideration when discussing treatment for slow-growing facial nonmelanoma skin cancer, say the authors.
“There are multiple ways to treat, all cancers aren’t the same, and skin cancer more often isn’t deadly,” coauthor Dr. Sunil Tholpady of the Indiana University School of Medicine in Indianapolis. Non-melanoma skin cancer refers to squamous cell carcinoma or basal cell carcinoma, Tholpady clarified.
“The decision to remove them or treat them in some fashion should consider the patient’s lifestyle, their necessities, and their desires as long as they comprehend what the course of the growth normally is,” he said.
Tholpady and his associates studied 440 adults over age 40 with 569 non-melanoma skin cancers on the face.
Around 55 percent were basal cell carcinomas and 30 percent were squamous cell carcinomas, they reported in JAMA Surgery. Overall, in about 33% of the cases, there was no cancer left in the skin after the lesion was removed for the biopsy. This was true for generally 50% of patients over age 90.
During the following several years, 50 patients died. Not surprisingly, the largest percentage of deaths was among patients in their 90s. Nobody died of the skin cancers, however.
In more than one of every three patients above age 80, and in more than half of those over 90, simply removing the lesion for biopsy left the patients cancer-free.
In other words, the scientists say, “a large minority of patients” would not have required more extensive medicines. Medicines for non-melanoma skin growths range from immunomodulatory creams to destructive treatments, for example, freezing, burning, shaving, and lasers, to surgery, said Tholpady.
Further, his group points out, the greater part of the patients who were in their 90s died within a year. “These small (cancers) could never have caused an issue,” the authors write.
Given that half of these oldest patients were free of cancer after their biopsies, “a solid argument can be made for a watchful waiting approach for the amenable nonagenarian,” they include.
Dr. Brian Gastman, director of melanoma surgery at Cleveland Clinic in Ohio, said a lot of money is spent each year on non-melanoma skin cancer, much of it in the elderly.
“Especially in the oldest-old, life expectancy “in theory would be substantially less than any non-melanoma skin cancer would take to actually cause death, and many are not generally life-threatening”.
Gastman said, the idea that some in elderly patients non-melanoma skin cancers can be monitored without formal treatment is “intriguing”, but the new information is not sufficiently definitive to change the standard of care.