Mohs surgery beneficial among older patients with high functional status

Patients older than 85 years with high functional status may benefit from Mohs surgery compared with common alternative treatments, according to data published in JAMA Dermatology.

Amanda Maisel-Campbell, MD, of the Feinberg School of Medicine in Chicago, and colleagues wrote that while surgery is safe even among patients aged 90 years and older, concerns have been raised about the necessity of surgery given limited functional status and life expectancy.

However, some studies have shown that patients aged older than 75 years and those aged older than 85 years who were more functional were more likely to receive surgery.

“Among older patients, Mohs surgery is associated with an improvement in survival of almost 2 years vs. similar cohorts who received other treatments,” the researchers wrote. “Risk assessments show that surgery has comparable adverse event rates in older and younger patients, and older patients receiving surgery also report being highly satisfied.”

To investigate treatment outcomes for older patients, Maisel-Campbell and colleagues conducted a prospective study that included 1,181 patients older than 85 years referred for Mohs surgery. Of those, 1,078 received Mohs surgery and 103 received alternative treatment.

A greater proportion of patients treated with Mohs surgery vs. those who received alternative treatment had tumors on the face (68.5% vs. 25.2%; P < .001), whereas a smaller proportion had lesions located on the trunk or extremities (13.8% vs. 43.7%; P < .001).

The researchers found that patients who received Mohs surgery also had a nearly fourfold increase in high functional status compared with those who received alternative treatments (57% vs. 15.5%; P < .001).

Commonly reported reasons for Mohs surgery in patients aged older than 85 years included patient desire for the treatment based on a high cure rate (66%), good or excellent patient functional status for their age (57%) and the high risk associated with the patient’s specific tumor (40.2%).

Maisel-Campbell and colleagues wrote that patient preference for Mohs surgery was cited among 2% of patients. However, while patients were involved in the discussion, a formal shared decision-making tool was not used. Had such a tool been used, the researchers noted it is possible that more patients may have shown a preference for the surgery.

“These findings suggest that patient functional status is associated with decisions on how cancers are treated, given that high-functioning status was among the most common reasons for surgery in patients older than age 85 years,” the researchers concluded. “This was second only to patient desire for high cure rate. These findings are consistent with prior work showing that most patients aged 75 years and older treated with Mohs surgery had high functional status.”