ABSTRACT
BACKGROUND: Functional status assessment may help estimate which patients ≥85 years of age will benefit from surgical treatment for keratinocyte carcinoma (KC), but predictive value for short-term survival in this population has not been determined. OBJECTIVE: We sought to assess the predictive value of functional status for short-term survival in patients ≥85 years of age who have KC. METHODS: This was a retrospective cohort review of 238 patients ≥85 years of age who presented for the management of KC between 2010 and 2015. Functional status was assessed with the Karnofsky Performance Scale (KPS) and Katz Activities of Daily Living (ADL) index. Overall survival was determined. RESULTS: Lower functional status scores of KPS ≤40 and Katz ADL ≤4 were associated with 37% and 53% survival at 2 years, respectively. LIMITATIONS: Retrospective design and single-center study. CONCLUSION: In this study, KPS and Katz ADL predicted short-term survival. Patients with low functional status scores had significantly decreased survival at 2 years, with double the death rate of patients with high functional status. Functional status should be considered during shared decision-making for elderly individuals who are seeking treatment for KC.
Subject(s)
Carcinoma, Basal Cell/mortality , Carcinoma, Squamous Cell/mortality , Functional Status , Skin Neoplasms/mortality , Age Factors , Aged, 80 and over , Carcinoma, Basal Cell/complications , Carcinoma, Basal Cell/diagnosis , Carcinoma, Basal Cell/pathology , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/pathology , Feasibility Studies , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Karnofsky Performance Status/statistics & numerical data , Keratinocytes/pathology , Male , Predictive Value of Tests , Retrospective Studies , Risk Assessment/methods , Skin Neoplasms/complications , Skin Neoplasms/diagnosis , Skin Neoplasms/pathologyABSTRACT
Melanoma presents challenges for timely and accurate diagnosis. Expert panels have issued risk-based screening guidelines, with recommended screening by visual inspection. To assess how recent technology can impact the risk/benefit considerations for melanoma screening, we comprehensively reviewed non-invasive visual-based technologies. Dermoscopy increases lesional diagnostic accuracy for both dermatologists and primary care providers; total body photography and sequential digital dermoscopic imaging also increase diagnostic accuracy, are supported by automated lesion detection and tracking, and may be best suited to use by dermatologists for longitudinal follow-up. Specialized imaging modalities using non-visible light technology have unproven benefit over dermoscopy and can be limited by cost, access, and training requirements. Mobile apps facilitate image capture and lesion tracking. Teledermatology has good concordance with face-to-face consultation and increases access, with increased accuracy using dermoscopy. Deep learning models can surpass dermatologist accuracy, but their clinical utility has yet to be demonstrated. Technology-aided diagnosis may change the calculus of screening; however, well-designed prospective trials are needed to assess the efficacy of these different technologies, alone and in combination to support refinement of guidelines for melanoma screening.