Skin Deep Decisions: Navigating Senior Skin Cancer

A skin cancer diagnosis can be frightening at any age, but there’s good news: it’s often one of the most treatable forms of cancer.

For years, the go-to approach has been surgical removal, considered the “gold standard” of care.

But as our population ages and skin cancer rates rise among older adults, a new conversation is emerging in the medical community.

Is aggressive surgical treatment always the best option for seniors?

Recent discussions at the ElderDerm conference, hosted by the Department of Dermatology at The George Washington University, have highlighted this growing debate.

As Dr. Vishal A. Patel, associate professor of dermatology and medicine/oncology at GWU, points out, “Surgery may be the gold standard for treating the majority of nonmelanoma skin cancers… but is it the [best option] for what our older patients and patients with limited life expectancy need?”

Let’s explore the different perspectives on this complex issue. We’ve highlighted the main points for each side:

The Case for Surgery:

• High cure rates, especially for high-risk tumors
• Definitive treatment that may provide peace of mind
• Well-established protocols and guidelines

The Case for Reconsidering:

• Increased risk of complications in older patients
• Potential impact on quality of life during recovery
• Limited life expectancy may not justify aggressive treatment
• Rising healthcare costs associated with widespread surgical intervention

Dr. Christina Prather, director of geriatrics and palliative medicine at GWU, emphasizes the importance of “age-friendly, whole-person care” that considers what truly matters to the patient. This approach is becoming increasingly crucial as older adults make up a larger portion of dermatology patients.

Some key points to consider:

• Risk Assessment: Thorough evaluation of the specific skin cancer type, location, and individual patient factors is crucial.
• Alternative Treatments: For some low-risk cancers, options like shave removal or disc excision during initial biopsy may be sufficient.
• Quality of Life: Consider how treatment might impact the patient’s daily life, independence, and overall well-being.
• Patient Preferences: Open discussions about goals of care and treatment preferences are essential.
• Emerging Options: New treatments like targeted immunotherapies may offer alternatives to surgery for some patients in the future.

If you or a loved one receives a skin cancer diagnosis, here are some actionable steps to take:

Start by asking questions. Understand the type of skin cancer, its risk level, and all available treatment options.

Then, while it may be uncomfortable, having an honest conversation about life expectancy can help inform treatment decisions. Think about how different treatments might impact your daily activities and overall well-being.

And if you’re unsure about the recommended treatment, don’t hesitate to consult another specialist for a second opinion.

For additional support, it can be helpful to include trusted family members or friends in the decision-making process.

Last, but not least, take your time. Unless it’s an emergency, take the time you need to make an informed decision that aligns with your values and goals.

Remember, there’s no one-size-fits-all approach to skin cancer treatment, especially for older adults. The best decision is one that balances medical best practices with individual patient needs and preferences.

By staying informed and engaged in your healthcare decisions, you can ensure that your treatment plan aligns with your personal goals and values.

To your health and well-informed choices,

Rachel Mace
Managing Editorial Director, e-Alert
with contributions from the research team

P.S. WWII ‘lifesaver’ defeats skin cancer? Get the details here.

Source:

ElderDerm conference, Department of Dermatology, The George Washington University, Washington, DC (2024)