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      Patients with Limited Life Expectancy Are Biopsied for Keratinocyte Cancers at Similar Frequency to Healthy Patients

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          Abstract

          Background: In many fields of medicine, guidelines recommend reduced cancer screening in patients of advanced age with 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 at the North Texas Veterans Affairs Health System dermatology clinic for 3,062 patients between 2005 and 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 versus 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 groups 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.

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          Author and article information

          Journal
          DRM
          Dermatology
          10.1159/issn.1018-8665
          Dermatology
          Dermatology
          S. Karger AG
          1018-8665
          1421-9832
          2023
          August 2023
          15 March 2023
          : 239
          : 4
          : 565-571
          Affiliations
          [_a] aDepartment of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
          [_b] bDepartment of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
          [_c] cDepartment of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
          [_d] dPeter O’Donnell Jr. School of Public Health & Psychiatry, University of Texas at Southwestern Medical Center, Dallas, Texas, USA
          Author notes
          *Heidi Jacobe, heidi.jacobe@utsouthwestern.edu
          Author information
          https://orcid.org/0000-0002-6199-0736
          https://orcid.org/0000-0002-4642-7769
          Article
          530103 Dermatology 2023;239:565–571
          10.1159/000530103
          36921586
          33b87457-e037-4785-8ff5-6b0c10295861
          © 2023 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.

          History
          : 13 June 2022
          : 06 March 2023
          Page count
          Figures: 3, Pages: 7
          Funding
          The research reported in this publication was supported by the James N. Gilliam Distinguished Chair in Dermatology and the National Center for Advancing Translation Sciences of the National Institutes of Health under Award Number UL1TR001105.
          Categories
          Skin Cancer – Research Article

          Medicine
          Basal cell carcinoma,Cohort study,Epidemiology,Limited life expectancy,Aging,Skin biopsy,Comorbidity,Keratinocyte cancer,Non-melanoma skin cancer,Clinical research,Squamous cell carcinoma

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