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Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature
A large percentage of the patients with keratinocyte carcinoma (KC, formerly known as non‐melanoma skin cancer) is of advanced age and often too frail for standard therapies. However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the cu...
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Published in: | Journal of the European Academy of Dermatology and Venereology 2020-09, Vol.34 (9), p.1932-1943 |
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container_end_page | 1943 |
container_issue | 9 |
container_start_page | 1932 |
container_title | Journal of the European Academy of Dermatology and Venereology |
container_volume | 34 |
creator | Leus, A.J.G. Frie, M. Haisma, M.S. Terra, J.B. Plaat, B.E.C. Steenbakkers, R.J.H.M. Halmos, G.B. Rácz, E. |
description | A large percentage of the patients with keratinocyte carcinoma (KC, formerly known as non‐melanoma skin cancer) is of advanced age and often too frail for standard therapies. However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the current literature on the best practice for the treatment of elderly patients with KC. A literature search was performed in MEDLINE, using ‘keratinocyte carcinoma’, ‘elderly’, ‘treatment’ and various synonyms. Case reports, reviews, comments, non‐English literature and studies with a sample size |
doi_str_mv | 10.1111/jdv.16268 |
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However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the current literature on the best practice for the treatment of elderly patients with KC. A literature search was performed in MEDLINE, using ‘keratinocyte carcinoma’, ‘elderly’, ‘treatment’ and various synonyms. Case reports, reviews, comments, non‐English literature and studies with a sample size <15 were excluded. After selection, a total of 47 studies were reviewed. Two types of studies were identified, focusing on (I) the effect of age on treatment outcomes and (II) alternative treatment schedules for elderly patients. Studies on surgery, the gold standard, describe larger lesions and defect size in the elderly population. Recurrence rate, complication rate and disease‐specific survival were not affected by age. Depending on the expected morbidity of a suggested (re‐)excision and patient preferences, a conservative watchful waiting policy can be agreed upon as a shared decision. Other common treatment modalities, such as adjuvant radiotherapy, photodynamic therapy and systemic therapy for basal cell carcinoma (BCC), show comparable results in the elderly and younger population. Alternative treatment schedules for elderly patients include primary hypofractionated radiotherapy, which seems effective and well‐tolerated, although research is limited to case series. Additionally, localized and topical treatments seem safe and effective especially for low‐risk tumours. Data are lacking on the efficacy of systemic therapies of metastatic KC in elderly patients. Efficacy of most treatments (with the exception of photodynamic therapy) is not dependent on age. There is need for more research on the efficacy of adjusted treatment modalities, such as hypofractionated radiotherapy and palliative or curative systemic treatment.</description><identifier>ISSN: 0926-9959</identifier><identifier>EISSN: 1468-3083</identifier><identifier>DOI: 10.1111/jdv.16268</identifier><identifier>PMID: 32030838</identifier><language>eng</language><publisher>England: John Wiley and Sons Inc</publisher><subject>Aged ; Carcinoma, Basal Cell - therapy ; Humans ; Keratinocytes ; Neoplasm Recurrence, Local ; Photochemotherapy ; Review ; Skin Neoplasms - therapy</subject><ispartof>Journal of the European Academy of Dermatology and Venereology, 2020-09, Vol.34 (9), p.1932-1943</ispartof><rights>2020 The Authors. published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology</rights><rights>2020 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4158-b00bc59db9aa9911c5a817b373d921c2cd3488c0aaf481682b97ae294f55c533</citedby><cites>FETCH-LOGICAL-c4158-b00bc59db9aa9911c5a817b373d921c2cd3488c0aaf481682b97ae294f55c533</cites><orcidid>0000-0002-9338-487X ; 0000-0002-9127-9283</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjdv.16268$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjdv.16268$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,315,786,790,891,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32030838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leus, A.J.G.</creatorcontrib><creatorcontrib>Frie, M.</creatorcontrib><creatorcontrib>Haisma, M.S.</creatorcontrib><creatorcontrib>Terra, J.B.</creatorcontrib><creatorcontrib>Plaat, B.E.C.</creatorcontrib><creatorcontrib>Steenbakkers, R.J.H.M.</creatorcontrib><creatorcontrib>Halmos, G.B.</creatorcontrib><creatorcontrib>Rácz, E.</creatorcontrib><title>Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature</title><title>Journal of the European Academy of Dermatology and Venereology</title><addtitle>J Eur Acad Dermatol Venereol</addtitle><description>A large percentage of the patients with keratinocyte carcinoma (KC, formerly known as non‐melanoma skin cancer) is of advanced age and often too frail for standard therapies. However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the current literature on the best practice for the treatment of elderly patients with KC. A literature search was performed in MEDLINE, using ‘keratinocyte carcinoma’, ‘elderly’, ‘treatment’ and various synonyms. Case reports, reviews, comments, non‐English literature and studies with a sample size <15 were excluded. After selection, a total of 47 studies were reviewed. Two types of studies were identified, focusing on (I) the effect of age on treatment outcomes and (II) alternative treatment schedules for elderly patients. Studies on surgery, the gold standard, describe larger lesions and defect size in the elderly population. Recurrence rate, complication rate and disease‐specific survival were not affected by age. Depending on the expected morbidity of a suggested (re‐)excision and patient preferences, a conservative watchful waiting policy can be agreed upon as a shared decision. Other common treatment modalities, such as adjuvant radiotherapy, photodynamic therapy and systemic therapy for basal cell carcinoma (BCC), show comparable results in the elderly and younger population. Alternative treatment schedules for elderly patients include primary hypofractionated radiotherapy, which seems effective and well‐tolerated, although research is limited to case series. Additionally, localized and topical treatments seem safe and effective especially for low‐risk tumours. Data are lacking on the efficacy of systemic therapies of metastatic KC in elderly patients. Efficacy of most treatments (with the exception of photodynamic therapy) is not dependent on age. There is need for more research on the efficacy of adjusted treatment modalities, such as hypofractionated radiotherapy and palliative or curative systemic treatment.</description><subject>Aged</subject><subject>Carcinoma, Basal Cell - therapy</subject><subject>Humans</subject><subject>Keratinocytes</subject><subject>Neoplasm Recurrence, Local</subject><subject>Photochemotherapy</subject><subject>Review</subject><subject>Skin Neoplasms - therapy</subject><issn>0926-9959</issn><issn>1468-3083</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNp1kblOxDAQhi0EguUoeAHkEoqAjzhrN0iIGyHRrCixHGcChhyLnSzajnfgDXkSHBYQFLixpfnmm5F_hLYp2afxHDwWs32asUwuoRFNM5lwIvkyGhHFskQpodbQegiPhBBKhVxFa5yRAZEjdDfxYLoamg63JX4CbzrXtHbeAbbG2_iuDXYNhqoAX83xNNYjHPD76xs22MPMwcvQ2j3Ejt77wVS5bhD1HjbRSmmqAFtf9waanJ1Oji-S65vzy-Oj68SmcaMkJyS3QhW5MkYpSq0wko5zPuaFYtQyW_BUSkuMKVNJM8lyNTbAVFoKYQXnG-hwoZ32eQ2FjUt4U-mpd7Xxc90ap_9WGveg79uZHqcq45mMgt0vgW-fewidrl2wUFWmgbYPmnHBMs6EZBHdW6DWtyF4KH_GUKKHOHSMQ3_GEdmd33v9kN__H4GDBfDiKpj_b9JXJ7cL5QdQ9Jdk</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Leus, A.J.G.</creator><creator>Frie, M.</creator><creator>Haisma, M.S.</creator><creator>Terra, J.B.</creator><creator>Plaat, B.E.C.</creator><creator>Steenbakkers, R.J.H.M.</creator><creator>Halmos, G.B.</creator><creator>Rácz, E.</creator><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9338-487X</orcidid><orcidid>https://orcid.org/0000-0002-9127-9283</orcidid></search><sort><creationdate>202009</creationdate><title>Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature</title><author>Leus, A.J.G. ; Frie, M. ; Haisma, M.S. ; Terra, J.B. ; Plaat, B.E.C. ; Steenbakkers, R.J.H.M. ; Halmos, G.B. ; Rácz, E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4158-b00bc59db9aa9911c5a817b373d921c2cd3488c0aaf481682b97ae294f55c533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Carcinoma, Basal Cell - therapy</topic><topic>Humans</topic><topic>Keratinocytes</topic><topic>Neoplasm Recurrence, Local</topic><topic>Photochemotherapy</topic><topic>Review</topic><topic>Skin Neoplasms - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leus, A.J.G.</creatorcontrib><creatorcontrib>Frie, M.</creatorcontrib><creatorcontrib>Haisma, M.S.</creatorcontrib><creatorcontrib>Terra, J.B.</creatorcontrib><creatorcontrib>Plaat, B.E.C.</creatorcontrib><creatorcontrib>Steenbakkers, R.J.H.M.</creatorcontrib><creatorcontrib>Halmos, G.B.</creatorcontrib><creatorcontrib>Rácz, E.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the European Academy of Dermatology and Venereology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leus, A.J.G.</au><au>Frie, M.</au><au>Haisma, M.S.</au><au>Terra, J.B.</au><au>Plaat, B.E.C.</au><au>Steenbakkers, R.J.H.M.</au><au>Halmos, G.B.</au><au>Rácz, E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature</atitle><jtitle>Journal of the European Academy of Dermatology and Venereology</jtitle><addtitle>J Eur Acad Dermatol Venereol</addtitle><date>2020-09</date><risdate>2020</risdate><volume>34</volume><issue>9</issue><spage>1932</spage><epage>1943</epage><pages>1932-1943</pages><issn>0926-9959</issn><eissn>1468-3083</eissn><notes>Conflicts of interest</notes><notes>Funding sources</notes><notes>The authors declare that they have no conflict of interest.</notes><notes>This research received no specific grant from any funding agency in the public, commercial or not‐for‐profit sectors.</notes><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><notes>ObjectType-Review-1</notes><notes>Due to the nature of study (review article), no IRB approval is required.</notes><notes>Both authors contributed equally to this manuscript.</notes><abstract>A large percentage of the patients with keratinocyte carcinoma (KC, formerly known as non‐melanoma skin cancer) is of advanced age and often too frail for standard therapies. However, no specific treatment recommendations are given for this population. This review aimed to give an overview of the current literature on the best practice for the treatment of elderly patients with KC. A literature search was performed in MEDLINE, using ‘keratinocyte carcinoma’, ‘elderly’, ‘treatment’ and various synonyms. Case reports, reviews, comments, non‐English literature and studies with a sample size <15 were excluded. After selection, a total of 47 studies were reviewed. Two types of studies were identified, focusing on (I) the effect of age on treatment outcomes and (II) alternative treatment schedules for elderly patients. Studies on surgery, the gold standard, describe larger lesions and defect size in the elderly population. Recurrence rate, complication rate and disease‐specific survival were not affected by age. Depending on the expected morbidity of a suggested (re‐)excision and patient preferences, a conservative watchful waiting policy can be agreed upon as a shared decision. Other common treatment modalities, such as adjuvant radiotherapy, photodynamic therapy and systemic therapy for basal cell carcinoma (BCC), show comparable results in the elderly and younger population. Alternative treatment schedules for elderly patients include primary hypofractionated radiotherapy, which seems effective and well‐tolerated, although research is limited to case series. Additionally, localized and topical treatments seem safe and effective especially for low‐risk tumours. Data are lacking on the efficacy of systemic therapies of metastatic KC in elderly patients. Efficacy of most treatments (with the exception of photodynamic therapy) is not dependent on age. There is need for more research on the efficacy of adjusted treatment modalities, such as hypofractionated radiotherapy and palliative or curative systemic treatment.</abstract><cop>England</cop><pub>John Wiley and Sons Inc</pub><pmid>32030838</pmid><doi>10.1111/jdv.16268</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-9338-487X</orcidid><orcidid>https://orcid.org/0000-0002-9127-9283</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Aged Carcinoma, Basal Cell - therapy Humans Keratinocytes Neoplasm Recurrence, Local Photochemotherapy Review Skin Neoplasms - therapy |
title | Treatment of keratinocyte carcinoma in elderly patients – a review of the current literature |
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