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The therapeutic dilemma of basal cell carcinoma in older adults : a review of the current literature

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Abstract
Skin cancer is known to be a significant health care threat due to the massively increasing numbers of diagnoses. In 2019, 4 million basal cell carcinoma (BCC) cases were diagnosed globally, making BCC the most frequent of all cancers worldwide in fair skinned populations. Given the increasing life-expectancy for all countries worldwide (by 2050, the world's population of people aged 60 years and older will have doubled), the incidence of BCC is expected to keep increasing in the future. Management of BCCs is challenging, especially among older adults, as mortality due to BCCs is extremely rare, whereas locally destructive growth can cause significant morbidity in certain cases. Therapeutic management in this population is further hampered because of the presence of comorbidities, frailty, and the heterogeneity of these aspects in older patients, leading to treatment dilemmas. A literature review was conducted to identify relevant patient, tumour, and treatment related factors that should be considered in the decision making for BCC treatment in older adults. This narrative review synthesizes all aspects concerning BCC treatment in older adults and aims to make some specific suggestions considering BCC treatment in older adults that can be used in daily practice. We found that nodular BCC was found to be the most common subtype in older adults, most frequently located in the head and neck region. In non-facial BCCs, current literature has shown no significant impact on the quality of life (QoL) in older patients. Besides comorbidity scores, functional status should guide clinicians in treatment decisions. Taking all aspects into account when making treatment decisions is of great importance. When treating superficial BCCs on difficult-to-reach lesions in older adults, a clinician-administered treatment should be suggested because of possible impaired mobility in these patients. Based on current literature, we recommend assessing the comorbidities, the functional status, and frailty in older patients with BCC to evaluate life expectancy. In patients with low-risk BCCs and a limited life expectancy (LLE), an active surveillance or watchful waiting strategy can be suggested.
Keywords
Geriatrics and Gerontology, Oncology, Watchful waiting, Older adults, Basal cell carcinoma

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MLA
Van Coile, Laura, et al. “The Therapeutic Dilemma of Basal Cell Carcinoma in Older Adults : A Review of the Current Literature.” JOURNAL OF GERIATRIC ONCOLOGY, vol. 14, no. 3, Elsevier BV, 2023, doi:10.1016/j.jgo.2023.101475.
APA
Van Coile, L., Verhaeghe, E., Ongenae, K., Destrooper, L., Mohamadi, Z., Brochez, L., & Hoorens, I. (2023). The therapeutic dilemma of basal cell carcinoma in older adults : a review of the current literature. JOURNAL OF GERIATRIC ONCOLOGY, 14(3). https://doi.org/10.1016/j.jgo.2023.101475
Chicago author-date
Van Coile, Laura, Evelien Verhaeghe, Katia Ongenae, Laura Destrooper, Zahra Mohamadi, Lieve Brochez, and Isabelle Hoorens. 2023. “The Therapeutic Dilemma of Basal Cell Carcinoma in Older Adults : A Review of the Current Literature.” JOURNAL OF GERIATRIC ONCOLOGY 14 (3). https://doi.org/10.1016/j.jgo.2023.101475.
Chicago author-date (all authors)
Van Coile, Laura, Evelien Verhaeghe, Katia Ongenae, Laura Destrooper, Zahra Mohamadi, Lieve Brochez, and Isabelle Hoorens. 2023. “The Therapeutic Dilemma of Basal Cell Carcinoma in Older Adults : A Review of the Current Literature.” JOURNAL OF GERIATRIC ONCOLOGY 14 (3). doi:10.1016/j.jgo.2023.101475.
Vancouver
1.
Van Coile L, Verhaeghe E, Ongenae K, Destrooper L, Mohamadi Z, Brochez L, et al. The therapeutic dilemma of basal cell carcinoma in older adults : a review of the current literature. JOURNAL OF GERIATRIC ONCOLOGY. 2023;14(3).
IEEE
[1]
L. Van Coile et al., “The therapeutic dilemma of basal cell carcinoma in older adults : a review of the current literature,” JOURNAL OF GERIATRIC ONCOLOGY, vol. 14, no. 3, 2023.
@article{01H7JYE42PF59WFGSJR9RKD965,
  abstract     = {{Skin cancer is known to be a significant health care threat due to the massively increasing numbers of diagnoses. In 2019, 4 million basal cell carcinoma (BCC) cases were diagnosed globally, making BCC the most frequent of all cancers worldwide in fair skinned populations. Given the increasing life-expectancy for all countries worldwide (by 2050, the world's population of people aged 60 years and older will have doubled), the incidence of BCC is expected to keep increasing in the future. Management of BCCs is challenging, especially among older adults, as mortality due to BCCs is extremely rare, whereas locally destructive growth can cause significant morbidity in certain cases. Therapeutic management in this population is further hampered because of the presence of comorbidities, frailty, and the heterogeneity of these aspects in older patients, leading to treatment dilemmas. A literature review was conducted to identify relevant patient, tumour, and treatment related factors that should be considered in the decision making for BCC treatment in older adults. This narrative review synthesizes all aspects concerning BCC treatment in older adults and aims to make some specific suggestions considering BCC treatment in older adults that can be used in daily practice. We found that nodular BCC was found to be the most common subtype in older adults, most frequently located in the head and neck region. In non-facial BCCs, current literature has shown no significant impact on the quality of life (QoL) in older patients. Besides comorbidity scores, functional status should guide clinicians in treatment decisions. Taking all aspects into account when making treatment decisions is of great importance. When treating superficial BCCs on difficult-to-reach lesions in older adults, a clinician-administered treatment should be suggested because of possible impaired mobility in these patients. Based on current literature, we recommend assessing the comorbidities, the functional status, and frailty in older patients with BCC to evaluate life expectancy. In patients with low-risk BCCs and a limited life expectancy (LLE), an active surveillance or watchful waiting strategy can be suggested.}},
  articleno    = {{101475}},
  author       = {{Van Coile, Laura and Verhaeghe, Evelien and Ongenae, Katia and Destrooper, Laura and Mohamadi, Zahra and Brochez, Lieve and Hoorens, Isabelle}},
  issn         = {{1879-4068}},
  journal      = {{JOURNAL OF GERIATRIC ONCOLOGY}},
  keywords     = {{Geriatrics and Gerontology,Oncology,Watchful waiting,Older adults,Basal cell carcinoma}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{7}},
  publisher    = {{Elsevier BV}},
  title        = {{The therapeutic dilemma of basal cell carcinoma in older adults : a review of the current literature}},
  url          = {{http://doi.org/10.1016/j.jgo.2023.101475}},
  volume       = {{14}},
  year         = {{2023}},
}

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