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

Abstract

A retrospective cohort study was undertaken to examine the management of basal cell carcinoma (BCC) in older patients. The aim was to identify subgroups where intervention could be minimised, based on frailty and trends in survival. All patients aged 90 years and over with histologically confirmed BCC during 2017 and 2018 were included within the study (n = 319). 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. 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.