Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study

Amanda Maisel-Campbell; Katherine A. Lin; Sarah A. Ibrahim; Bianca Y. Kang; Noor Anvery; McKenzie A. Dirr; Rachel E. Christensen; Juliet L. Aylward; Omar Bari; Hamza Bhatti; Diana Bolotin; Basil S. Cherpelis; Joel L. Cohen; Sean Condon; Sheila Farhang; Bahar Firoz; Algin B. Garrett; Roy G. Geronemus; Nicholas J. Golda; Tatyana R. Humphreys; Eva A. Hurst; Oren H. Jacobson; S. Brian Jiang; Pritesh S. Karia; Arash Kimyai-Asadi; David J. Kouba; James G. Lahti; Martha Laurin Council; Marilyn Le; Deborah F. MacFarlane; Ian A. Maher; Stanley J. Miller; Eduardo K. Moioli; Meghan Morrow; Julia Neckman; Timothy Pearson; Samuel R. Peterson; Christine Poblete-Lopez; Chad L. Prather; Jennifer S. Ranario; Ashley G. Rubin; Chrysalyne D. Schmults; Andrew M. Swanson; Christopher Urban; Y. Gloria Xu; Murad Alam; Simon Yoo; Emily Poon; Vishnu Harikumar; Alexandra Weil; Sanjana Iyengar; Matthew R. Schaeffer

doi:10.1001/jamadermatol.2022.1733

Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study

Amanda Maisel-Campbell, Katherine A. Lin, Sarah A. Ibrahim, Bianca Y. Kang, Noor Anvery, McKenzie A. Dirr, Rachel E. Christensen, Juliet L. Aylward, Omar Bari, Hamza Bhatti, Diana Bolotin, Basil S. Cherpelis, Joel L. Cohen, Sean Condon, Sheila Farhang, Bahar Firoz, Algin B. Garrett, Roy G. Geronemus, Nicholas J. Golda, Tatyana R. HumphreysEva A. Hurst, Oren H. Jacobson, S. Brian Jiang, Pritesh S. Karia, Arash Kimyai-Asadi, David J. Kouba, James G. Lahti, Martha Laurin Council, Marilyn Le, Deborah F. MacFarlane, Ian A. Maher, Stanley J. Miller, Eduardo K. Moioli, Meghan Morrow, Julia Neckman, Timothy Pearson, Samuel R. Peterson, Christine Poblete-Lopez, Chad L. Prather, Jennifer S. Ranario, Ashley G. Rubin, Chrysalyne D. Schmults, Andrew M. Swanson, Christopher Urban, Y. Gloria Xu, Murad Alam, Simon Yoo, Emily Poon, Vishnu Harikumar, Alexandra Weil, Sanjana Iyengar, Matthew R. Schaeffer

Research output: Contribution to journal › Article › peer-review

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Abstract

IMPORTANCE: It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs.

OBJECTIVE: To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019.

EXPOSURES: Mohs surgery for nonmelanoma skin cancer.

MAIN OUTCOMES AND MEASURES: Reason for treatment selection.

RESULTS: Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]).

CONCLUSIONS AND RELEVANCE: This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.

Original language	English (US)
Pages (from-to)	770-778
Number of pages	9
Journal	JAMA Dermatology
Volume	158
Issue number	7
DOIs	https://doi.org/10.1001/jamadermatol.2022.1733
State	Published - Jul 1 2022

Keywords

Aged
Carcinoma, Basal Cell/pathology
Female
Humans
Male
Mohs Surgery
Private Practice
Prospective Studies
Skin/pathology
Skin Neoplasms/pathology

ASJC Scopus subject areas

Dermatology

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10.1001/jamadermatol.2022.1733

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Maisel-Campbell, A., Lin, K. A., Ibrahim, S. A., Kang, B. Y., Anvery, N., Dirr, M. A., Christensen, R. E., Aylward, J. L., Bari, O., Bhatti, H., Bolotin, D., Cherpelis, B. S., Cohen, J. L., Condon, S., Farhang, S., Firoz, B., Garrett, A. B., Geronemus, R. G., Golda, N. J., ... Schaeffer, M. R. (2022). Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study. JAMA Dermatology, 158(7), 770-778. https://doi.org/10.1001/jamadermatol.2022.1733

Maisel-Campbell, A, Lin, KA, Ibrahim, SA, Kang, BY, Anvery, N, Dirr, MA, Christensen, RE, Aylward, JL, Bari, O, Bhatti, H, Bolotin, D, Cherpelis, BS, Cohen, JL, Condon, S, Farhang, S, Firoz, B, Garrett, AB, Geronemus, RG, Golda, NJ, Humphreys, TR, Hurst, EA, Jacobson, OH, Jiang, SB, Karia, PS, Kimyai-Asadi, A, Kouba, DJ, Lahti, JG, Council, ML, Le, M, MacFarlane, DF, Maher, IA, Miller, SJ, Moioli, EK, Morrow, M, Neckman, J, Pearson, T, Peterson, SR, Poblete-Lopez, C, Prather, CL, Ranario, JS, Rubin, AG, Schmults, CD, Swanson, AM, Urban, C, Xu, YG, Alam, M, Yoo, S, Poon, E, Harikumar, V, Weil, A, Iyengar, S & Schaeffer, MR 2022, 'Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study', JAMA Dermatology, vol. 158, no. 7, pp. 770-778. https://doi.org/10.1001/jamadermatol.2022.1733

@article{2fe45c9ab7994586a90ff2634489fef1,

title = "Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study",

abstract = "IMPORTANCE: It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs.OBJECTIVE: To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals.DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019.EXPOSURES: Mohs surgery for nonmelanoma skin cancer.MAIN OUTCOMES AND MEASURES: Reason for treatment selection.RESULTS: Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]).CONCLUSIONS AND RELEVANCE: This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.",

keywords = "Aged, Carcinoma, Basal Cell/pathology, Female, Humans, Male, Mohs Surgery, Private Practice, Prospective Studies, Skin/pathology, Skin Neoplasms/pathology",

author = "Amanda Maisel-Campbell and Lin, {Katherine A.} and Ibrahim, {Sarah A.} and Kang, {Bianca Y.} and Noor Anvery and Dirr, {McKenzie A.} and Christensen, {Rachel E.} and Aylward, {Juliet L.} and Omar Bari and Hamza Bhatti and Diana Bolotin and Cherpelis, {Basil S.} and Cohen, {Joel L.} and Sean Condon and Sheila Farhang and Bahar Firoz and Garrett, {Algin B.} and Geronemus, {Roy G.} and Golda, {Nicholas J.} and Humphreys, {Tatyana R.} and Hurst, {Eva A.} and Jacobson, {Oren H.} and Jiang, {S. Brian} and Karia, {Pritesh S.} and Arash Kimyai-Asadi and Kouba, {David J.} and Lahti, {James G.} and Council, {Martha Laurin} and Marilyn Le and MacFarlane, {Deborah F.} and Maher, {Ian A.} and Miller, {Stanley J.} and Moioli, {Eduardo K.} and Meghan Morrow and Julia Neckman and Timothy Pearson and Peterson, {Samuel R.} and Christine Poblete-Lopez and Prather, {Chad L.} and Ranario, {Jennifer S.} and Rubin, {Ashley G.} and Schmults, {Chrysalyne D.} and Swanson, {Andrew M.} and Christopher Urban and Xu, {Y. Gloria} and Murad Alam and Simon Yoo and Emily Poon and Vishnu Harikumar and Alexandra Weil and Sanjana Iyengar and Schaeffer, {Matthew R.}",

note = "Funding Information: Funding/Support: This study was supported by departmental research funds from the Department of Dermatology at Northwestern University. Publisher Copyright: {\textcopyright} 2022 American Medical Association. All rights reserved.",

year = "2022",

month = jul,

day = "1",

doi = "10.1001/jamadermatol.2022.1733",

language = "English (US)",

volume = "158",

pages = "770--778",

journal = "JAMA Dermatology",

issn = "2168-6068",

publisher = "American Medical Association",

number = "7",

}

TY - JOUR

T1 - Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery

T2 - A Prospective, Multicenter Cohort Study

AU - Maisel-Campbell, Amanda

AU - Lin, Katherine A.

AU - Ibrahim, Sarah A.

AU - Kang, Bianca Y.

AU - Anvery, Noor

AU - Dirr, McKenzie A.

AU - Christensen, Rachel E.

AU - Aylward, Juliet L.

AU - Bari, Omar

AU - Bhatti, Hamza

AU - Bolotin, Diana

AU - Cherpelis, Basil S.

AU - Cohen, Joel L.

AU - Condon, Sean

AU - Farhang, Sheila

AU - Firoz, Bahar

AU - Garrett, Algin B.

AU - Geronemus, Roy G.

AU - Golda, Nicholas J.

AU - Humphreys, Tatyana R.

AU - Hurst, Eva A.

AU - Jacobson, Oren H.

AU - Jiang, S. Brian

AU - Karia, Pritesh S.

AU - Kimyai-Asadi, Arash

AU - Kouba, David J.

AU - Lahti, James G.

AU - Council, Martha Laurin

AU - Le, Marilyn

AU - MacFarlane, Deborah F.

AU - Maher, Ian A.

AU - Miller, Stanley J.

AU - Moioli, Eduardo K.

AU - Morrow, Meghan

AU - Neckman, Julia

AU - Pearson, Timothy

AU - Peterson, Samuel R.

AU - Poblete-Lopez, Christine

AU - Prather, Chad L.

AU - Ranario, Jennifer S.

AU - Rubin, Ashley G.

AU - Schmults, Chrysalyne D.

AU - Swanson, Andrew M.

AU - Urban, Christopher

AU - Xu, Y. Gloria

AU - Alam, Murad

AU - Yoo, Simon

AU - Poon, Emily

AU - Harikumar, Vishnu

AU - Weil, Alexandra

AU - Iyengar, Sanjana

AU - Schaeffer, Matthew R.

N1 - Funding Information: Funding/Support: This study was supported by departmental research funds from the Department of Dermatology at Northwestern University. Publisher Copyright: © 2022 American Medical Association. All rights reserved.

PY - 2022/7/1

Y1 - 2022/7/1

N2 - IMPORTANCE: It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs.OBJECTIVE: To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals.DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019.EXPOSURES: Mohs surgery for nonmelanoma skin cancer.MAIN OUTCOMES AND MEASURES: Reason for treatment selection.RESULTS: Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]).CONCLUSIONS AND RELEVANCE: This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.

AB - IMPORTANCE: It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs.OBJECTIVE: To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals.DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019.EXPOSURES: Mohs surgery for nonmelanoma skin cancer.MAIN OUTCOMES AND MEASURES: Reason for treatment selection.RESULTS: Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]).CONCLUSIONS AND RELEVANCE: This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.

KW - Aged

KW - Carcinoma, Basal Cell/pathology

KW - Female

KW - Humans

KW - Male

KW - Mohs Surgery

KW - Private Practice

KW - Prospective Studies

KW - Skin/pathology

KW - Skin Neoplasms/pathology

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DO - 10.1001/jamadermatol.2022.1733

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Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study

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