Patients with limited life expectancy are biopsied for keratinocyte cancers at similar frequency to healthy patients.

BACKGROUND: In many fields of medicine, guidelines recommend reduced cancer screening in patients of advanced age and limited life expectancy (LLE). In dermatology, there are currently no guidelines for adjusted evaluation and management practices of keratinocyte cancer (KC) in patients with LLE. Little is known regarding evaluation and management patterns and frequency of biopsies in these patients.

OBJECTIVE: We sought to determine if dermatology providers biopsy LLE patients with similar frequency to their age-matched peers and quantify frequency of associated complications.

METHODS: This was a retrospective cohort study of evaluations for skin cancer quantified by skin biopsy frequency for skin cancer at the North Texas Veteran Affairs Health System dermatology clinic for 3062 patients between 2005-2009, including a 5-year follow-up period. Life expectancy was quantified by the validated Charlson Comorbidity Index (CCI) with a Deyo adaptation.

RESULTS: There was no significant difference in biopsy frequency of KC in LLE vs non-LLE patients in most age-controlled groups, with increased biopsy frequency in LLE patients in the 65-74 age category (p=0.02). There was also an increased risk of complications from biopsy in the 75-84 (many comorbidities subgroup: RR=3.27, p=0.002; some comorbidities subgroup: RR=2.26, p=0.048) and 65-74 (many comorbidities subgroup: RR=1.52, p=0.004) age group when compared to age matched healthy controls.

CONCLUSION: Biopsy frequency is similar or increased in patients with LLE compared with age-matched controls, with increased frequency of complications. Further studies are needed to understand the underlying factors driving these practice patterns.