University of Utah School of Medicine, Salt Lake City, Utah, USA.
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Clin Dermatol. 2019 Jul-Aug;37(4):373-378. doi: 10.1016/j.clindermatol.2019.06.004. Epub 2019 Jun 16.
Basal cell carcinoma (BCC) is the most commonly diagnosed type of skin cancer. BCCs are especially prevalent in the elderly population, given their association with cumulative sun exposure and other risk factors. In this contribution, we outline geriatric concepts related to the care of older adults with BCCs. We describe how a patient's life expectancy can be estimated and combined with tumor characteristics to determine lag time to benefit, a concept to better understand whether patients will experience the efficacy of a treatment within their life span. We also review the possibility of current BCC overdiagnosis and summarize the effectiveness, benefits, and risks of common treatments for BCCs, noting that all treatment modalities have special considerations when administered to older adults. In particular, nonsurgical treatments might be preferable for older adults with a limited life expectancy. Ultimately, we argue that the decision of whether and how to treat a BCC should be the result of shared decision-making between the provider and the patient and take into account not only tumor characteristics, but also patient values and preferences.
基底细胞癌（BCC）是最常见的皮肤癌类型。鉴于其与累积的阳光暴露和其他风险因素有关，BCC 在老年人群中尤为普遍。在本贡献中，我们概述了与老年人 BCC 护理相关的老年医学概念。我们描述了如何估计患者的预期寿命，并将其与肿瘤特征相结合，以确定获益延迟时间，这一概念有助于更好地理解患者是否会在其寿命内体验到治疗的效果。我们还回顾了当前 BCC 过度诊断的可能性，并总结了常见 BCC 治疗方法的有效性、益处和风险，指出所有治疗方法在为老年人治疗时都有特殊的考虑因素。特别是，对于预期寿命有限的老年人，非手术治疗可能更为可取。最终，我们认为是否以及如何治疗 BCC 的决定应该是提供者和患者之间共同决策的结果，不仅要考虑肿瘤特征，还要考虑患者的价值观和偏好。
