Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Life Expectancy Scores in Very Elderly with NMSC

J Am Acad Dermatol; ePub 2017 Dec 26; Rogers, et al

The Adult Comorbidity Evaluation-27 (ACE-27) and the age-adjusted Charlson Comorbidity Index (ACCI) predicted limited life expectancy (LLE) in the very elderly with nonmelanoma skin cancer (NMSC), a recent study found. The cohort presenting for Mohs micrographic surgery, however, had improved survival, despite similar inter-cohort comorbidity. This suggests that additional factors contributed to survival, and that age and comorbidities alone are inadequate for making NMSC treatment decisions in the very elderly. A retrospective review of 488 patients aged ≥85 years presenting for NMSC management between July 1999 through December 2014 was performed. Comorbidities were scored using ACE-27 and ACCI. Dates of death, follow-up, and overall survival were determined. Researchers found:

  • ACE-27 and ACCI scores were associated with overall survival; scores of 3 and 7+, respectively, were associated with <50% survival at 4 years.
  • Mohs surgery patients survived a median of 20 months longer than non-Mohs patients.

Rogers EM, Connolly KL, Nehal KS, Dusza SW, Rossi AM, Lee E. Comorbidity scores associated with limited life expectancy in the very elderly with nonmelanoma skin cancer. [Published online ahead of print December 26, 2017]. J Am Acad Dermatol. doi:10.1016/j.jaad.2017.12.048.

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