engleski

Therapeutic options of non-melanoma skin cancer in elderly

Non-melanoma skin cancer (NMSC) is the most common human cancer, with increasing incidence in the last decades. Cumulative sun exposure has the main role in the development of NMSC, so a higher prevalence of NMSC in the elderly is expected. A median age at diagnosis is 71 years. Of all NMSC, approximately 80% include basal cell carcinoma (BCC) and 20% squamous cell carcinoma (SCC). Other skin tumors account for about 1% of NMSC. In the elderly, therapy for NMSC can be surgical and nonsurgical. Surgical treatment of NMSC is the most effective treatment that provides high cure rate of over 90% for both SCC and BCC, and over 95% for BCC. Despite the high cure rates achieved with surgery, this treatment modality is associated with the risk of morbidities such as infections, which may be fatal in this age group. Other therapeutic modalities depend on tumor localization, histological type, and biologic behavior, as well as patient comorbidities, age, and life expectancy. Nonsurgical treatments include cryotherapy, local therapies (imiquimod, 5-fluorouracil, ingenol- mebutate, and diclofenac), photodynamic therapy, radiotherapy, and hedgehog inhibitors. Some of these treatments can be combined with curettage and electrodesiccation for better outcomes. Every treatment modality has advantages and disadvantages that must be carefully considered individually. Because the facial area is the most common localization of NMSC, treatment modalities with better cosmetic outcome are preferred. Many times, despite good clinical condition, a surgery is refused by the patient because of their age. Patient life expectancy, functional and socioeconomic status, and quality of life should be taken in consideration when choosing the most suitable treatment modality for this non-fatal disease. Surgical excision after the procedure requires outpatient visits, which can be inconvenient because older patients are dependent on others because of the transport and a home care. On the other hand, nonsurgical treatments also require outpatient visits because of the novel applications which are sometimes unfamiliar to the patients. After choosing the best therapeutic option for a patient, it is crucial that the patient’s quality of life is preserved in this sensitive age.

non-melanoma skin cancer ; elderly ; treatment

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