Department of Dermatology, Feinberg School of Medicine, Chicago, Illinois.
Department of Dermatology, Columbia University Medical Center, New York, New York.
JAMA Dermatol. 2022 Jul 1;158(7):770-778. doi: 10.1001/jamadermatol.2022.1733.
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.
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.
Mohs surgery for nonmelanoma skin cancer.
Reason for treatment selection.
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%]).
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.
有人认为，对于预期寿命有限的个体进行皮肤癌的 Mohs 手术可能会带来不必要的风险和不适，同时增加医疗保健费用。
调查临床医生对老年个体非黑素瘤皮肤癌治疗的患者和肿瘤特定适应症的考虑。
设计、地点和参与者：这项多中心前瞻性队列研究使用了来自美国私人诊所和学术中心的数据。纳入的患者年龄大于 85 岁，患有皮肤癌并接受皮肤癌手术，参考组为年龄小于 85 岁接受 Mohs 手术的患者和年龄大于 85 岁不接受 Mohs 手术的患者。数据于 2018 年 11 月至 2019 年 1 月进行分析。
Mohs 手术治疗非黑素瘤皮肤癌。
治疗选择的原因。
在 22 个地点接受 Mohs 手术治疗的 1181 名年龄大于 85 岁的患者中（1169 名患者中有 724 名男性[61.9%]，1176 名患者中有 681 名年龄大于 85 至 88 岁[57.9%]），1078 名患者（91.3%）接受了 Mohs 手术治疗，103 名患者（8.7%）接受了替代治疗。接受 Mohs 手术治疗的患者更有可能患有面部肿瘤（738 例[68.5%] vs 26 例[25.2%]；P<.001），且近 4 倍更有可能具有较高的功能状态（614 例[57.0%] vs 16 例[15.5%]；P<.001）。外科医生选择进行 Mohs 手术的 15 个不同原因中，最常见的原因是患者希望接受高治愈率的治疗（712 例[66.0%]）、良好或极佳的患者年龄相关功能状态（614 例[57.0%]）以及基于组织学的高肿瘤风险（433 例[40.2%]）。
本研究发现，接受 Mohs 手术治疗的老年患者通常具有较高的功能状态、高风险肿瘤和位于面部的肿瘤。这些发现表明，鉴于他们的肿瘤可能具有侵袭性、疼痛、毁容和引起焦虑，及时进行手术治疗可能是合适的。
