Possible Overdiagnosis of Basal Cell Carcinoma in Elderly Patients

In the United States, over 2.5 million patients are diagnosed with Basal Cell Carcinoma (BBC), compared to 1.7 million other cancers. The majority of these BBCs develop in elderly individuals 65 years old and up; and every year more than 100,000 BBCs are treated in patients who will eventually die within a year. Over the past 15 years, Skin Cancer removal procedures have increased twofold; surgeons are opting to perform Mohs Surgery, histologically guided serial excision, and increased 400% between 1995 and 2009. Many physicians have implied that we are in the midst of a Skin Cancer epidemic caused by prolonged exposure to the sun, a thinning ozone layer and a rise in indoor tanning. These statics are apt to increase more, as the number of older adults doubles between 2010 and 2013, general Cancer occurrences are estimated to increase nearly 50%.

Regardless of these staggering numbers BBCs develop gradually, and treated BBCs rarely metastasize and are seldom lethal. Deaths from Basal Cell Carcinoma are extremely low, despite the fact that the number of patients diagnosed BBCs has increased drastically during the past 20 years. Non-Melanoma Skin Cancer mortality occurs in approximately 1 in 1,000 cases, but these deaths predominately result from Squamous Cell Carcinoma, not BBC. Patients diagnosed with BBC during their last year of life typically die of causes not related to these lesions.

Symptomatic vs. Screening Detected BBCs

Certain BBCs present with troublesome symptoms. Skin lesions can ulcerate, encumber the eyelids or ears, and result in itching, pain or bleeding in 12% of patients. When suffering from these symptoms, or evident tumors, patients usually make an appointment with their physician. For these patients, a Facial Cosmetic Surgeon is vital for presenting an accurate diagnosis and treatment plan for the offending tumors. Many BBCs go unnoticed by patients, usually identified by physicians during examinations.

Elderly patients have a higher possibility of being diagnosed with Basal Cell Carcinomas, but also present the utmost risk for unintended impairment. These may include: anxiety caused by a Cancer diagnosis, fear of metastasis or recurrence (though highly unlikely, or unpleasant side effects from treatment. Fragile elderly patients suffering from multiple, chronic conditions are more apt to grapple with Skin Cancer treatments, such as enduring long procedures, trouble with wound care and dressing changes, or ineffective wound healing.

Asymptomatic BBC treatment is necessary because they may grow, resulting in symptoms or necessitate extensive surgery in the future. Even though BBCs are classified as slow-growing tumors, how gradually an average BBC develops is equivocal. Will a tumor cause problems in decades, years or months? There is no clear-cut answer. Some patients indicate that they have had them for years before they become bothersome. Many Facial Cosmetic Surgeons would concur with the original observation by Jacob deduced in 1824, “…the slowness with which this disease proceeds is very remarkable.”

The Institute of Medicine recently recommended changes in Cancer treatment, emphasizing patient-focused communication and shared decision making as its main priority. Due to the ambiguity of the natural history of BBCs and their characteristically slothful disposition, patients with BBC will probably vacillate in their decisions to undergo biopsies or treatments. Especially, to assist sicker patients and their families make educated choices about slow-growing skin lesions, more facts and guidelines that integrate the risks and benefits of diagnosing, referring and treating these lesions are necessary.

If you suspect that you have Basal Cell Carcinoma or another type of Skin Cancer, schedule a consultation with Facial Cosmetic Surgeon Dr. Oleh Slupchynskyj to discuss treatment options and put your mind at ease.