Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery: A Prospective, Multicenter Cohort Study.

Importance: It has been suggested that Mohs surgery for skin cancer among individuals with limited life expectancy may be associated with needless risk and discomfort, along with increased health care costs. Objective: To investigate patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older individuals. Design, Setting, and Participants: This multicenter, prospective cohort study was conducted using data from US private practice and academic centers. Included patients were those older than age 85 years presenting for skin cancer surgery and referred for Mohs surgery, with reference groups of those younger than age 85 years receiving Mohs surgery and those older than age 85 years not receiving Mohs surgery. Data were analyzed from November 2018 through January 2019. Exposures: Mohs surgery for nonmelanoma skin cancer. Main Outcomes and Measures: Reason for treatment selection. Results: Among 1181 patients older than age 85 years referred for Mohs surgery (724 [61.9%] men among 1169 patients with sex data; 681 individuals aged >85 to 88 years [57.9%] among 1176 patients with age data) treated at 22 sites, 1078 patients (91.3%) were treated by Mohs surgery, and 103 patients (8.7%) received alternate treatment. Patients receiving Mohs surgery were more likely to have tumors on the face (738 patients [68.5%] vs 26 patients [25.2%]; P < .001) and nearly 4-fold more likely to have high functional status (614 patients [57.0%] vs 16 patients [15.5%]; P < .001). Of 15 distinct reasons provided by surgeons for opting to proceed with Mohs surgery, the most common were patient desire for treatment with a high cure rate (712 patients [66.0%]), good or excellent patient functional status for age (614 patients [57.0%]), and high risk associated with the tumor based on histology (433 patients [40.2%]). Conclusions and Relevance: This study found that older patients who received Mohs surgery often had high functional status, high-risk tumors, and tumors located on the face. These findings suggest that timely surgical treatment may be appropriate in older patients given that their tumors may be aggressive, painful, disfiguring, and anxiety provoking.

Measurement of the anatomic position of the corrugator supercilii.

OBJECTIVE: To standardize the location of the corrugator supercilii by using known facial landmarks. METHODS: The corrugator supercilii points of origin, insertion, and maximal muscle thickness were measured relative to the nasion and supraorbital notch in 21 cadavers. Comparisons of measurements between male and female cadavers were performed using a two-tailed t-test. RESULTS: The location of the corrugator supercilii was variable but was not significantly different between males and females. From the nasion, the mean point of origin was 4 mm lateral and 6 mm superior, the mean point of insertion was 33 mm lateral and 16 mm superior, and the mean maximal muscle thickness was 16 mm lateral and 10 mm superior. At their point of greatest thickness, most corrugators were found to lie below the upper border of the superciliary arch. CONCLUSIONS: There is variability in the location of the corrugator supercilii that is not gender dependent. When injecting botulinum toxin into the corrugator supercilii, it might be advantageous if the lower forehead skin of the brow is elevated, thus allowing for more precise injection. This may achieve weakness of the targeted muscle with lower doses of botulinum toxin, thus lessening the risk of eyelid and brow ptosis.