Department of Dermatology, University Hospital Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Belgium.
Faculty of Medicine and Health Sciences, Ghent University, Belgium.
J Geriatr Oncol. 2023 Apr;14(3):101475. doi: 10.1016/j.jgo.2023.101475. Epub 2023 Mar 27.
Skin cancer is known to be a significant health care threat due to the massively increasing numbers of diagnoses. In 2019, 4 million basal cell carcinoma (BCC) cases were diagnosed globally, making BCC the most frequent of all cancers worldwide in fair skinned populations. Given the increasing life-expectancy for all countries worldwide (by 2050, the world's population of people aged 60 years and older will have doubled), the incidence of BCC is expected to keep increasing in the future. Management of BCCs is challenging, especially among older adults, as mortality due to BCCs is extremely rare, whereas locally destructive growth can cause significant morbidity in certain cases. Therapeutic management in this population is further hampered because of the presence of comorbidities, frailty, and the heterogeneity of these aspects in older patients, leading to treatment dilemmas. A literature review was conducted to identify relevant patient, tumour, and treatment related factors that should be considered in the decision making for BCC treatment in older adults. This narrative review synthesizes all aspects concerning BCC treatment in older adults and aims to make some specific suggestions considering BCC treatment in older adults that can be used in daily practice. We found that nodular BCC was found to be the most common subtype in older adults, most frequently located in the head and neck region. In non-facial BCCs, current literature has shown no significant impact on the quality of life (QoL) in older patients. Besides comorbidity scores, functional status should guide clinicians in treatment decisions. Taking all aspects into account when making treatment decisions is of great importance. When treating superficial BCCs on difficult-to-reach lesions in older adults, a clinician-administered treatment should be suggested because of possible impaired mobility in these patients. Based on current literature, we recommend assessing the comorbidities, the functional status, and frailty in older patients with BCC to evaluate life expectancy. In patients with low-risk BCCs and a limited life expectancy (LLE), an active surveillance or watchful waiting strategy can be suggested.
皮肤癌是一种严重的健康威胁，因为诊断数量在大幅增加。2019 年，全球有 400 万例基底细胞癌（BCC）确诊，使 BCC 成为全世界所有癌症中在白种人群中最常见的癌症。考虑到全球所有国家的预期寿命都在增加（到 2050 年，世界上 60 岁及以上人口将增加一倍），BCC 的发病率预计未来还会继续上升。BCC 的管理具有挑战性，尤其是在老年人中，因为 BCC 导致的死亡率极低，而局部破坏性生长在某些情况下会导致严重的发病率。由于合并症、虚弱和这些方面在老年患者中的异质性，这一人群的治疗管理进一步受到阻碍，导致治疗困境。进行了文献回顾，以确定应在老年人 BCC 治疗决策中考虑的与患者、肿瘤和治疗相关的因素。本综述综合了有关老年人 BCC 治疗的所有方面，并旨在根据老年人 BCC 治疗提出一些具体建议，这些建议可用于日常实践。我们发现，结节状 BCC 是老年人中最常见的亚型，最常发生在头部和颈部。在非面部 BCC 中，现有文献表明其对老年患者的生活质量（QoL）没有显著影响。除了合并症评分外，功能状态也应指导临床医生做出治疗决策。在做出治疗决策时，考虑所有方面非常重要。在治疗老年人难以触及的部位的浅表性 BCC 时，由于这些患者可能行动不便，建议采用临床医生管理的治疗方法。基于现有文献，我们建议评估患有 BCC 的老年人的合并症、功能状态和虚弱程度，以评估预期寿命。对于低风险 BCC 且预期寿命有限（LLE）的患者，可以建议采用主动监测或观察等待策略。
