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 was to identify subgroups where intervention could be minimised, based on frailty and trends in survival.

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

Results: Age was the most significant predictor of survival (HR=1.10 (95% CIs: 1.04-1.17); p=0.001). Maximum threshold analysis identified 93 years as the significant age cutpoint. Median survival was 40 months for ≤93 years and 28 months for >93 years (p=0.002). Patients with dementia had a worse survival than those without (median survival: 25 months versus 35 months, respectively; HR=1.92 (95% CIs: 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 those observed (n=25) (median survival 34 months versus 21 months, respectively; HR= 0.54 (95% CIs: 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.