Dermatologic surgery in geriatric patients: psychosocial considerations and perioperative decision-making

Evaluating complications in below-knee skin cancer surgery after introduction of preoperative appointments: A 2-year retrospective cohort study

Below-knee dermatological surgery has a high risk of complications such as wound infection, bleeding, and necrosis. In this study, we evaluated the impact of preoperative appointments on complication risks. We searched the medical records of the Helsinki University Central Hospital (HUS) Dermatosurgery unit for all below-knee surgeries during 2016, when no preoperative nurse appointments were carried out, and compared it with 2018, when preoperative appointments for risk patients were introduced. The study included 187 patients in 2016 and 179 patients in 2018, of whom 68 (about one third) attended preoperative appointments. At the appointments, risk factors were evaluated, and compression therapy was introduced when possible. The results show complication rates of 13.4% in 2016 vs 10.1% in 2018 (P = .33), despite significantly higher risks in the 2018 patient group. The odds ratio for complications in appointment attendees vs non-attendees was reduced after adjustments to 0.58; however, this was insignificant (P = .47). The odds of complications for skin grafts were considerably higher: 11.33 vs other surgery techniques (P = .00). In conclusion, the introduction of preoperative appointments appeared to reduce complications in below-knee surgery. For graft reconstructions, complication risk is high, even with carefully planned pre- and postoperative care. Further studies are needed to evaluate preventable risk factors of below-knee graft reconstructions.

[Dermatosurgery in the elderly]

In recent decades, the portion of elderly has increased substantially due to demographic changes in developed countries. Dermatological surgery is particularly affected by this development, because a large proportion of the elderly suffer from skin tumors, which are primarily treated surgically. Physiological changes of age and multimorbidity, often associated with polypharmacy, present the treating physician with enormous challenges. What aspects of care are important? What must be considered? What are possible complications and how can they be prevented? These important questions are answered. Finally, selected surgical approaches for the care of very old patients are also described.

Skin cancer in elderly patients

The role of the dermatologist who provides care to the geriatric patient assumes the care for the integument system. The ability to diagnose and treat cancerous lesions effectively with special care given to the needs of the geriatric patient is considered indispensable. The clinician should accept the responsibility of skin cancers and obtain biopsies with empathy and care.