According this study, authors said that age of the patient and relative lifespan could be taken into consideration when discussing treatment for slow-growing facial nonmelanoma skin cancer. Non-melanoma skin cancer refers to squamous cell carcinoma or basal cell carcinoma. This study is published in JAMA Surgery.

Tholpady described, The decision to cut them out or treat them in some fashion should consider the patient's lifestyle, their needs, and their wishes as long as they understand what the course of the cancer usually. Tholpady and his colleagues studied 440 adults over age 40 with 569 non-melanoma skin cancers on the face. About 55% were basal cell carcinomas and 30% were squamous cell carcinomas.

Overall, in about a third of the cases, there was no cancer left in the skin after the lesion was removed for the biopy. This was true for roughly half of patients over age 90. During the next several years, 50 patients died. Not surprisingly, the largest percentage of deaths was among patients in their 90s. No one died of the skin cancers.

In more than one in three patients above age 80, and in more than half of those above 90, simply removing the lesion for biopsy left the patients cancer-free. In other words, the researchers say, “a large minority of patients” would not have needed more extensive treatments. Treatments for non-melanoma skin cancers range from immunomodulatory creams, to destructive therapies such as freezing, burning, shaving and lasers, to surgery, said Tholpady.

Further, his team points out, more than half of the patients who were in their 90s died within a year. ” These small (cancers) would never have caused a problem,” the authors write. Given that half of these oldest patients were free of cancer after their biopsies, “a strong argument can be made for a watchful-waiting approach for the amenable nonagenarian,” they add.

Gastman told, “Particularly in the oldest-old, life expectancy “in theory would be much less than any non-melanoma skin cancer would take to cause death, and many are not generally life-threatening.” Even complete margin assessment, which is not the standard of care does not focus on the non-marginal tissue, Gastman explained.

“Meaning, it is quite possible that within the inflamed/scarred biopsy site harbors more cancer, but these individual cells or nest of cells are not observed via the methods used in this study.” Furthermore, the investigation of the biopsy specimen could require special assays that might not be employed on “garden-variety” skin cancer being resected in standard-of-care fashion.

Author concludes, Future studies are needed to investigate if a watchful-waiting approach is cost-effective and has higher patient approval than surgical excision in this elderly population.