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

Abstract

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.