Mohs Surgery May Be Appropriate for Many Patients Older than 85 Years

Mohs surgery is used to treat certain types of nonmelanoma skin cancers and may be appropriate for older patients with high functional status, high-risk tumors, and tumors on the face due to their aggressive, painful, disfiguring, and anxiety provoking nature. Although surgical treatment is safe even in adults older than 90, whether older adults with limited life expectancy and limited functional ability should undergo skin cancer surgery is concerning.

Researchers investigated factors associated with the decision to proceed with Mohs surgery in patients older than 85. The results of the study were published in JAMA Dermatology.

The study was a prospective, multicenter cohort study of 1181 patients older than 85 years, of whom 1078 were treated with Mohs surgery and further analysis. The remaining 103 patients received a different type of treatment.

The researchers found that patients who underwent Mohs surgery were more likely to have tumors on their faces, which was noted as “consistent with the expectation that Mohs surgery is most useful on the face.” Those who underwent the procedure also had a nearly 4-fold greater chance of having higher functional status

The 3 most common reasons surgeons gave for proceeding with Mohs surgery in this cohort were patient’s desire for treatment with a high cure rate, good or excellent patient functional status for their age, and a high-risk tumor histology.

Older patients living in nursing homes and those living alone tended to present with larger preoperative tumors, and patients older than 88 tended to have less social support. These factors may be associated with tumor neglect and growth, noted the researchers.

“Our findings suggest that Mohs surgery may be particularly appropriate in some older patients given that their tumors can be more aggressive, and their social support may be more limited,” the researchers concluded. Additionally, surgical cure may reduce the burden of recurrent disease and use of self-applied treatments.

Although the researchers noted this study involved “one of the largest prospective cohorts of older patients undergoing skin cancer surgery,” it was not population-based. Additional limitations included older patients with limited life expectancy who were not referred for Mohs surgery were not included. The reasons for proceeding with surgery were assigned by the surgeons, so there also was the possibility of bias, as the surgeons felt they needed to justify their choices.

Disclosures: Multiple authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Maisel-Campbell A, Lin KA, Ibrahim SA, et al. Nonmelanoma skin cancer in patients older than age 85 years presenting for Mohs surgery: a prospective, multicenter cohort study. JAMA Dermatology. Published online May 25, 2022. doi:10.1001/jamadermatol.2022.1733