The patient is a 100 year-old widow who lives independently in an apartment complex. She’s been on supplemental oxygen for almost 20 years. She has friends who visit regularly, but no close relatives nearby. She enjoys life and is a great sports fan.
She has a biopsy proven nodular basal cell on the left second toe and a biopsy proven superficial squamous cell carcinoma involving most of the dorsum of left middle finger. The closest Mohs surgeon is an hour away.
Clinical Photos
Discussion: Optimal treatment of these lesions would be
micrographic surgery, but this may be too aggressive for this relatively frail
woman and wound care at home would be difficult. Individuals of this age may
not live long enough to benefit from “gold standard” therapy, however,
unchecked tumor progression can worsen their quality of life if treatment is
withheld. Radiotherapy would also be difficult as many trips for fractionated care would be taxing for her.
There are few therapeutic guidelines for patients like this. We would appreciate your suggestions as we plan to address the patient and her tumors.
References:
1. A J G Leus, et. al. Treatment of keratinocyte carcinoma in elderly patients - a review of the current literature. J Eur Acad Dermatol Venereol. 2020 Sep;34(9):1932-1943. Free PMC article
2. Christopher McLaughlin, Mark A Russell. Single-fraction high-dose palliative radiotherapy for facial cutaneous squamous cell carcinoma: a case report. Ann Palliat Med. 2022 Oct;11(10):3337-3340.
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