Treatment of advanced skin carcinoma in elderly people.

Background Advanced skin carcinoma, according to TNM classification, is as a lesion in stage III or IV (T3-T4, N0-N1, M0-M1) greater than 5 cm in greatest diameter (T3). It can infiltrate extradermal tissues (T4) or it can have local lymph node metastasis (N1) or distant metastasis (M1). In a large percentage of these patients, local relapses with deep infiltration, regional lymph node metastasis or distant metastases may be encountered. Current literature reports only few papers about advanced stage casistics. Therefore we reviewed our experience with elderly patients presenting skin carcinomas in advanced stage, to evaluate the incidence of this disorder among the whole number of skin carcinomas, the operability of those patients, the immediate clinical response to the surgical treatment and their follow-up. Materials and methods From January 1st 2005 to June 30th 2009 we observed and treated 412 patients with skin carcinomas Only patients with confirmed histopathological diagnosis of skin carcinoma were included in the study. The advanced stage of disease was established by physical examination and instrumental imaging exams. Results The more frequent diagnoses were basal cell carcinomas, squamous cell carcinoma and porocarcinoma. Among this group, we found 37 advanced stage carcinomas (T3-T4), that is 8.98 % of patients with skin carcinoma. All patients were over 75 years old with median age of 81 years (range 75-88). Most patients presented systemic disorders. Thirty six out of 37 patients were surgically operated. Only one was not operated because of his severe heart failure. In all patients within 1 month from the surgical operation, all surgical flaps and grafts were well nourished. One year later only 24 patients came to the check-up and all of them were alive and without any tumor relapse. Conclusions Our percentage of advanced stage skin carcinomas in elderly people (8,9 %) is particularly notable in comparison with other casistics reported in the literature that commonly present a percentage of about 3% [1-4]. We must take into account that our Institute is sited in the center of Calabria, a region of Southern Italy quite homogeneous for population and lifestyle. Many inhabitants are old and with a history of working as fishermen or farmers and consequently exposed for long periods to the sun rays. [ABSTRACT FROM AUTHOR]