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Skin Cancer Tx Mostly Surgical, Regardless of Life Expectancy

For nonmelanoma skin cancer, treatment choice unaffected by patient prognosis

Skin Cancer Tx Mostly Surgical, Regardless of Life Expectancy

WEDNESDAY, May 8 (HealthDay News) -- Regardless of patient life expectancy, most cases of nonmelanoma skin cancer (NMSC) are treated surgically, according to a study published online April 29 in JAMA Internal Medicine.

Eleni Linos, M.D., Dr.P.H., from the University of California in San Francisco, and colleagues recruited consecutive patients diagnosed with NMSC at two dermatology clinics in 1999 through 2000 and followed them for a median of nine years. In the final analysis, 1,360 patients with 1,739 tumors were included. Patients aged 85 years or older at diagnosis or with multiple comorbidities were defined as having limited life expectancy (LLE). The options for treatment were no treatment, destruction, or surgery (elliptical excision or Mohs surgery).

The researchers found that, regardless of patient life expectancy, 69 percent of NMSCs were treated surgically. When adjusting for tumor and patient characteristics, the choice of surgery was not influenced by patient prognosis. Within five years of enrollment, 43 percent of patients with LLE died, none from NMSC. Only 3.7 percent of all patients experienced tumor recurrence at five years. Complications of therapy were reported by 20 percent of patients with LLE, compared to 15 percent in other patients, although serious complications were unusual.

"Most NMSCs were treated surgically in patients with LLE, and treatment choices were unaffected by patient prognosis," the authors write. "We hope that this study will open the debate to optimal treatment decisions for NMSC, facilitating shared decision making and informed discussion about patient prognosis."

One author is a consultant for Genentech.

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