Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/or antiplatelet-anticoagulants. Five year experience in our Hospital

Arguello-Guerra, Lilia; Vargas-Chandomid, Estefanía; Díaz-González, José Manuel; Méndez‐Flores, Silvia; Ruelas-Villavicencio, Ana Lilia; Domínguez‐Cherit, Judith

doi:10.24875/cirue.m18000003

Cited by 5 publications

(15 citation statements)

References 35 publications

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“…In contrast, several other studies found that the complication rate after treatment of KC was not different between young and elderly patients with more comorbidities, suggesting that (surgical) treatment is safe in this group, despite the higher comorbidity rate in elderly patients ( 26 , 32 , 33 ).…”

Section: Resultsmentioning

confidence: 65%

“…Harmonizing with these findings, a recent retrospective study including 927 KC found that patients having ≥ 4 comorbidities were significantly more likely to receive no treatment (31). In contrast, several other studies found that the complication rate after treatment of KC was not different between young and elderly patients with more comorbidities, suggesting that (surgical) treatment is safe in this group, despite the higher comorbidity rate in elderly patients (26,32,33).…”

Section: Comorbiditymentioning

confidence: 96%

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Effect of Patient Characteristics on Treatment Decisions Regarding Keratinocyte Carcinoma in Elderly Patients: A Review of the Current Literature

Haisma

Bras²,

Aghdam³

et al. 2020

Acta Derm Venereol

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This study collected data about the effect of patient characteristics (life expectancy, frailty and comorbidity) on treat ment decisions in elderly people with keratinocyte carcinoma, by searching PubMed database. Literature about how patient characteristics affect treatment decision is sparse and is mostly based on small retrospective studies. Therefore, it is difficult to give firm recommendations. A "one-size-fits-all" approach to this population is not sufficient: life expectancy, frailty and comorbidities must be taken into account in the decision-making about treatment, and registered using a validated scoring system, especially before major treatment modalities.There are straightforward guidelines for treatment of keratinocyte carcinoma (formerly known as non-melanoma skin cancer); however, there are no clear recommendations specifically for elderly patients. The aim of this review was to provide an overview of the current literature about the effect of patient characteristics, specifically life expectancy, frailty and comorbidity, on treatment decisions in elderly patients with keratinocyte carcinoma, by searching PubMed database. It was found that the literature is limited and based mostly on small retrospective studies. Therefore, it is difficult to give firm recommendations about how to treat elderly people who have keratinocyte carcinoma. A "one-sizefits-all" approach to this population is not sufficient: life expectancy and frailty need to be considered in the decision-making process regarding treatment for elderly people with keratinocyte carcinoma. Among the comorbidity scores, Adult-Comorbidity-Evaluation-27-index seems to have the best prognostic value. Prospective studies are needed to generate more individualized recommendations for this increasing and often vulnerable group.

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Section: Resultsmentioning

confidence: 65%

Section: Comorbiditymentioning

confidence: 96%

Effect of Patient Characteristics on Treatment Decisions Regarding Keratinocyte Carcinoma in Elderly Patients: A Review of the Current Literature

Haisma

Bras²,

Aghdam³

et al. 2020

Acta Derm Venereol

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“…Of the 13 articles, four were prospective observational cohort studies, one was a retrospective case-control study, and the remaining eight were retrospective observational cohort studies (Appendix S1). [15][16][17][18][19][20][21][22][23][24][25][26][27] Over 12 years, there were 10,750 patients who underwent cutaneous surgery, with 1,312 of them performed on patients prescribed a DOAC. The mean participant age ranged from 68 to 78.8 years of age, with a male predominance (49.9-81.8%).…”

Section: Resultsmentioning

confidence: 99%

Direct oral anticoagulants in skin surgery: a systematic review of their complications and recommendations for perioperative management

Ireland,

Borruso,

Spencer

et al. 2023

Int J Dermatology

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IntroductionMany patients undergoing cutaneous surgery are prescribed at least one anticoagulant or antiplatelet agent. With the recent emergence of direct oral anticoagulants (DOACs), there is a deficit of knowledge regarding optimal perioperative management. This review aims to evaluate the evidence and risk surrounding management of DOACs in patients undergoing skin surgeries.MethodsSystematic review of EMBASE, Scopus, and PubMed, with inclusion of studies that detailed perioperative management of DOACs in those undergoing skin surgery. Primary outcome measures were perioperative hemorrhagic and thromboembolic complications.ResultsSeven thousand seven hundred and forty‐one abstracts were identified, with 13 articles meeting inclusion criteria. Two studies investigated complication risk associated with DOAC continuation in skin surgery and found an average rate of hemorrhagic complications of 1.74%. Two studies evaluated complications associated with DOAC cessation prior to skin surgery, with a pooled thromboembolic complication rate of 0.15%. Articles comparing continuation and cessation discovered no decreased risk of bleeding with DOAC cessation prior to surgery (P = 0.93). Seven of the 13 articles compared complications in a control vs a DOAC group undergoing cutaneous procedures. Evidence was conflicting but may have suggested a small increase in bleeding risk in those on DOAC therapy.ConclusionOptimal management of anticoagulants perioperatively is difficult because of conflicting information, complicated by advent of novel agents. Risk of hemorrhagic complications with both continuation and interruption of DOAC therapy was low. Perioperative DOAC management can be guided by procedural bleeding and patient clotting risk and can often be continued in minor dermatologic procedures.

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“…It was not clear whether and how much skin malignancies were included [35]. Several other studies found that comorbidities did not influence (wound) complication rate after treatment of KC [32, 36, 37].…”

Section: Discussionmentioning

confidence: 99%

Influence of Frailty and Life Expectancy on Guideline Adherence and Outcomes in Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Prospective Pilot Study

et al. 2022

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Background: Cutaneous squamous cell carcinoma is the second most common malignancy of the skin, often occurring in older patients and in the head and neck area (cSCCHN). Age, life expectancy, and frailty are not taken into consideration by current guidelines. Objectives: The objective of this study was to evaluate the influence of frailty and life expectancy on guideline deviation, treatment outcomes, and quality of life (QoL) after treatment in patients with cSCCHN. Methods: Patients with cSCCHN were prospectively included. A geriatric assessment was performed, including the Geriatric 8 (G8), Groningen Frailty Indicator, and Timed Up and Go test (TUG). The Lee index was used to predict a limited life expectancy, and the Adult Comorbidity Evaluation-27 was used as a comorbidity index. QoL was assessed by the Basal and Squamous cell carcinoma Quality of Life (BaSQoL) questionnaire at three time points. Results: Seventy-seven patients with cSCCHN were included. Frail patients had significantly more high-risk tumours. Guideline deviation occurred in 7.8% and was more common in patients who were frail (G8), with high-risk tumours (≥T2), with a limited life expectancy or an increased TUG. Guideline deviation did not lead more often to progression of disease in our study. No predictors for post-operative complications were found. BaSQoL subscores were very low at each time point and did not change significantly with time in the total group. Frail patients reported more fear of recurrence or new tumours 3 months after treatment, and less concern about other people’s skin 6 months after treatment, compared to non-frail patients. Complication rate, gender, or guideline deviation did not affect any subscale scores. Conclusions: Assessment of frailty and life expectancy can guide physicians and patients in treatment decisions. Deviation from guidelines towards less aggressive treatment schedules can be considered in frail patients with a limited life expectancy, since it did not negatively affect short-term outcomes or QoL in patients with cSCCHN in our study. However, these results should be confirmed by other, larger prospective studies with a longer follow-up period.

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Incidence of complications in dermatological surgery of melanoma and non-melanoma skin cancer in patients with multiple comorbidity and/or antiplatelet-anticoagulants. Five year experience in our Hospital

Abstract: Incidencia de complicaciones en cirugía dermatológica de cáncer de piel melanoma y no melanoma en pacientes con múltiple comorbilidad o antiagregantes-anticoagulantes. Experiencia de nuestro hospital durante 5 años

Cited by 5 publications

References 35 publications

Effect of Patient Characteristics on Treatment Decisions Regarding Keratinocyte Carcinoma in Elderly Patients: A Review of the Current Literature

Effect of Patient Characteristics on Treatment Decisions Regarding Keratinocyte Carcinoma in Elderly Patients: A Review of the Current Literature

Direct oral anticoagulants in skin surgery: a systematic review of their complications and recommendations for perioperative management

Influence of Frailty and Life Expectancy on Guideline Adherence and Outcomes in Cutaneous Squamous Cell Carcinoma of the Head and Neck: A Prospective Pilot Study

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