This article is more than 5 years old. Information may no longer be current.
Mohs surgery safely treated nonagenarians, older patients
Patients aged 90 years and older may safely undergo Mohs micrographic surgery, according to study results.
Researchers studied 214 patients in this age group (average age, 92.3 years; 50% men) who underwent Mohs micrographic surgery (MMS) from July 1997 to May 2006 at a private dermatology clinic or a hospital-based outpatient clinic. Information gathered included tumor type, size, site, defect size, number of MMS stages and surgical repair. Charlson index was used to assess comorbid medical conditions. Expected length of survival and actual survival were assessed through life tables.
There were 148 basal cell carcinomas (BCC) and 66 squamous cell carcinomas (SCC), and all tumors were primary. MMS was well tolerated by all patients, with no complications and no deaths within 1 month of surgery. Median survival was 36.9 months after surgery (BCC, 37.9 months; SCC, 29.5 months).
“Tumor characteristics, defect size, number of surgical stages and closure type did not affect survival,” the researchers reported. “The number of stages of surgery performed ranged from 1 to 8. … There was no difference in survival between patients who underwent 1 or 2 stages and those who had 3 or more stages (P<.41).”
Based on comorbidities, no significant differences in survival were observed. Instantaneous mortality hazard assessed that the chance of dying was greatest 2 to 3 years after MMS.
“Except for the expected survival advantage of women over men in this age group, no health status or procedure-related effects on mortality were identified,” the researchers concluded, stating that the study was limited because specific causes of death were not accessible. “This growing section of the population can safely undergo MMS and should not be relegated to other less effective treatments through fear of affecting their survival.”
Perspective
Back to Top
Because of the country’s growing elderly population, Delaney and colleagues opted to investigate whether Mohs micrographic surgery (MMS) is safe in patients aged 90 years or older. Their findings reveal that 214 nonagenerian patients treated with MMS over 9 years at multiple practice settings (eg, hospital-based, private practice) did not die within 3 months of their surgery.
While there are multiple lessons to be gleaned from this study, one key principle must be reinforced: cutaneous oncologic surgery performed under local anesthesia is safe. This study adds to the wealth of literature that demonstrates the safety of procedures performed under local anesthesia. What is most noteworthy in this current study is that the nonagenerian patient survival was independent of the tumor type, tumor size, duration of surgery and reconstruction type.
As America’s population ages, more citizens will undoubtedly be affected by melanoma and nonmelanoma skin cancers. These tumors can inflict significant morbidity and their treatment can relieve patients of pain, cosmetic disfigurement, and locoregional or distant metastasis. MMS provides patients with the highest cure rate for skin cancers by ensuring precise microscopic margin control while preserving noncancerous adjacent tissue that allows for easier wound healing or less extensive surgical reconstruction.
Healthy nonagenerian patients need not be thought of as poor outpatient surgical candidates. The study by Delaney et al supports the notion that MMS is safe, even for patients 90 years and older.