Less invasive surgery preferred for some NMSC

When selecting patients for nonmelanoma skin cancer treatment, physicians should consider if the lesion affects the patient’s functionality, researchers reported at the 2017 American Society for Dermatologic Surgery annual meeting in Chicago on Thursday.

During the opening session of the meeting, Michael Renzi, M.D., said that although nonmelanoma skin cancer (NMSC) is rarely a fatal diagnosis, these lesions can have a significant impact on the quality of life for afflicted patients - especially the elderly.

Nonmelanoma skin cancer treatment is most often effectively treated with Mohs micrographic surgery, but it’s not always a practical option. So, in this study, researchers examined how different treatments for nonmelanoma skin cancer were applied to elderly patients with low functionality. The Karnofsky Performance Status (KPS) scale was used to categorize a patient’s functional status.

The study included 203 patients, 75 years old or older, who were undergoing biopsy for suspected nonmelanoma skin cancer and who met the criteria for Mohs micrographic surgery. The dermatologist choosing the treatment was blinded to the functionality assessment.

Low functionality was defined as a KPS score of less than 60.  Most of these patients, 97.5% or 198 patients, were high functioning with a KPS score of 60 or higher. Seventy percent of these patients were treated with a surgical modality (Mohs micrographic surgery for 56.1% of this group).

Only, 2.5% or five patients, had KPS scores of less than 60 and four of these patients were treated with electrodessication and curettage. The fifth patient was referred for Mohs micrographic surgery due to a painful, bleeding tumor on the face.

Physicians should “utilize less invasive modalities for patients with poor functional status, even when the tumor meets the appropriate use criteria (AUC) for Mohs micrographic surgery (MMS),” Dr. Renzi said.

Reference

“Assessing the Functionality of Patients When Determining the Appropriate Treatment for Nonmelanoma Skin Cancers," 2017 American Society for Dermatologic Surgery Association annual meeting, Oct. 5, 2017.