Identification and Management of Malignant Skin Lesions Among Older Adults

Close and positive margins in non-melanoma skin malignancies of the head and neck. What to do in patients over 75 years of age? A preliminary study

BACKGROUND

The incidence of non-melanoma skin cancer (NMSC) of the head and neck is increasing among older adults where it is credited to have a poorer prognosis also because the radicality of the surgery is often missed for a too conservative approach. An assessment of the amount of tumor regrowth and its prognostic consequences, in patients with surgical margins close or involved and older than 75 years, seems thus worth to be pursued in order to provide the best therapeutic strategy.

METHODS

91 cases of basal cell carcinomas (BBC) and squamous cell carcinomas (SCC), in patients older than 75 years of age, were followed from a minimum of one year to up to ten years. 15 patients had close margins at histology while 30 patients turned out to have positive margins. The other 46 patients had clear histologic margins and were considered as a control group. Several parameters were also considered like the site of occurrence, morphology, grading, size, thickness, type of margin involved (lateral, deep or both) and the status of the neck, for the SCC. A cut-off follow-up of two years (less than two years and more than two years) was adopted.

RESULTS

Among the BCCs there was one recurrence in the clear margin subgroup (1/23-4.3%) and two in the positive margin subgroup (2/20-10%). For the SCCs there was only one recurrence in the group of positive margins (1/10-10%). Hence the observed rate of recurrence was much lower than reported in the literature.

CONCLUSIONS

In the authors' opinion the low tendency to recur that NMSC shows in people older than 75 years might validate, at least in this age group, an "economic" surgical approach and a watchful attitude. Larger numbers are needed to assess and possibly validate this strategy, especially for the SCCs.