Clinical outcomes of the management of basal cell carcinomas in individuals aged 90 years and over: a retrospective cohort study.

BACKGROUND

A retrospective cohort study was undertaken to examine the management of basal cell carcinoma (BCC) in older patients.

OBJECTIVES

The aim of this study was to identify subgroups where intervention could be minimized, based on frailty and trends in survival.

METHODS

All patients aged ≥ 90 years with histologically confirmed BCC during 2017 and 2018 were included within the study (n = 319).

RESULTS

Age was the most significant predictor of survival [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.04-1.17; P = 0.001]. Maximum threshold analysis identified 93 years as the significant age cutpoint. Median survival was 40 months for patients aged ≤ 93 years and 28 months for those aged > 93 years (P = 0.002). Patients with dementia had a worse survival than those without (median survival 25 months vs. 35 months, respectively; HR 1.92, 95% CI 1.18-3.13; P = 0.009). There was a statistically significant difference in survival for patients who received treatment for their BCC (n = 294) compared with the untreated cohort (n = 25) (median survival 34 months vs. 21 months, respectively; HR 0.54, 95% CI 0.34-0.85; P = 0.007). All other comorbidities examined had no influence on survival.

CONCLUSIONS

This study provides evidence in support of active treatment of BCC in individuals aged ≥ 90 years, seen in secondary care. Conservative options may be preferable in patients with dementia or those > 93 years old.