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Optimizing Informed Decision Making for Basal Cell Carcinoma in Patients 85 Years or Older

Erica H. Lee, MD1; Jerry D. Brewer, MD2; Deborah F. MacFarlane, MD, MPH3
[+] Author Affiliations
1Memorial Sloan Kettering Cancer Center, New York, New York
2Mayo Clinic, Rochester, Minnesota
3MD Anderson Cancer Center, Dallas, Texas
JAMA Dermatol. 2015;151(8):817-818. doi:10.1001/jamadermatol.2015.1454.
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This viewpoint emphasizes the importance of elderly patients’ involvement in their own BCC treatment decisions and the need for dermatologists and primary physicians together to adapt management plans to the patient’s values, preferences, and social circumstances.

In the United States, the population 85 years or older is projected to grow from 5.9 million in 2012 to 8.9 million in 2030.1 An estimated 2 million skin cancer procedures are performed annually,2 200 000 in individuals 85 years or older. A variety of arguments have been proposed to minimize treatment of basal cell carcinoma (BCC) in those 85 years or older, including cost considerations and concerns over potential adverse effects of treatment.3 There may also be misconceptions about the tolerability and safety of treatment options in the very elderly population (defined as oldest-old [≥85 years]). An open dialogue between the physician caring for the patient, the patient, and family members the patient wants to include will aid in optimizing the care of such patients with BCC. The elements of this discussion must include the following: (1) the biological behavior of the tumor based on the anatomic location; (2) the pathologic findings of the biopsy; (3) treatment options and anticipated results; (4) time to achieve the final result within the anticipated life expectancy of the individual; and (5) cost and duration of care.

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