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Multicenter Study
. 2022 Jul 1;158(7):770-778.
doi: 10.1001/jamadermatol.2022.1733.

Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study

Amanda Maisel-Campbell  1   2 , Katherine A Lin  1 , Sarah A Ibrahim  1 , Bianca Y Kang  1 , Noor Anvery  1 , McKenzie A Dirr  1 , Rachel E Christensen  1 , Juliet L Aylward  3 , Omar Bari  4   5 , Hamza Bhatti  6   7 , Diana Bolotin  8 , Basil S Cherpelis  9 , Joel L Cohen  10   11 , Sean Condon  12   13 , Sheila Farhang  9   14 , Bahar Firoz  6 , Algin B Garrett  15 , Roy G Geronemus  16   17 , Nicholas J Golda  18 , Tatyana R Humphreys  19   20 , Eva A Hurst  21   22 , Oren H Jacobson  23   24 , S Brian Jiang  4 , Pritesh S Karia  25 , Arash Kimyai-Asadi  26 , David J Kouba  27   28 , James G Lahti  29 , Martha Laurin Council  21 , Marilyn Le  19 , Deborah F MacFarlane  30 , Ian A Maher  31   32 , Stanley J Miller  33 , Eduardo K Moioli  8 , Meghan Morrow  1 , Julia Neckman  17   34 , Timothy Pearson  12   35 , Samuel R Peterson  23   36 , Christine Poblete-Lopez  12 , Chad L Prather  37 , Jennifer S Ranario  30   38 , Ashley G Rubin  4   39 , Chrysalyne D Schmults  25 , Andrew M Swanson  3 , Christopher Urban  21   40 , Y Gloria Xu  3 , Murad Alam  1 ; Dermbase Research Group; Simon Yoo  1 , Emily Poon  1 , Vishnu Harikumar  1 , Alexandra Weil  1 , Sanjana Iyengar  1   41 , Matthew R Schaeffer  1   42
Affiliations
Multicenter Study

Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study

Amanda Maisel-Campbell et al. JAMA Dermatol. .

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bolotin reported serving as principal investigator on a clinical trial sponsored by Replimune outside the submitted work. Dr Cohen reported serving as a clinical investigator, consultant, or speaker or trainer for Accure, Allergan, Almirall/Athenex, Avuta, Biofrontera Bioscience, Biopelle, Brickell Biotech, Croma, Elta, Endo Pharmaceuticals, Ferndale, Galderma, InMode, IntraDerm, Lutronic, Merz, Novan, PCA, Pulse Biosciences, Raziel, Recros Medica, Revance, Revision, Sciton, and Sente outside the submitted work. Dr Council reported receiving personal fees from Sanofi-Genzyme Regeneron, AbbVie, and Castle Biosciences outside the submitted work. Dr Schmults reported serving as the National Comprehensive Cancer Network nonmelanoma panel chair, on the American Society for Dermatologic Surgery board of directors, and as International Society for Dermatologic and Aesthetic Surgery secretary. No other disclosures were reported.

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