Date Published: April 22, 2019
Publisher: Public Library of Science
Author(s): Merve Akdeniz, Elisabeth Hahnel, Claas Ulrich, Ulrike Blume-Peytavi, Jan Kottner, Raffaele Serra.
Non-melanoma-skin cancer is an emerging clinical problem in the elderly, fair skinned population which predominantly affects patients aged older than 70 years. Its steady increase in incidence rates and morbidity is paralleled by related medical costs. Despite the fact that many elderly patients are in need of care and are living in nursing homes, specific data on the prevalence of skin cancer in home care and the institutional long-term care setting is currently lacking. A representative multicenter prevalence study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n = 223 residents were included. Actinic keratoses, the precursor lesions of invasive cutaneous squamous cell carcinoma were the most common epithelial skin lesions (21.1%, 95% CI 16.2 to 26.9). Non-melanoma skin cancer was diagnosed in 16 residents (7.2%, 95% CI 4.5 to 11.3). None of the residents had a malignant melanoma. Only few bivariate associations were detected between non-melanoma skin cancer and demographic, biographic and functional characteristics. Male sex was significantly associated with actinic keratosis whereas female sex was associated with non-melanoma skin cancer. Smoking was associated with an increased occurrence of non-melanoma skin cancer. Regular dermatology check-ups in nursing homes would be needed but already now due to financial limitations, lack of time in daily clinical practice and limited number of practising dermatologists, it is not the current standard. With respect to the worldwide growing aging population new programs and decisions are required. Overall, primary health care professionals should play a more active role in early diagnosis of skin cancer in nursing home residents. Dermoscopy courses, web-based or smartphone-based applications and teledermatology may support health care professionals to provide elderly nursing home residents an early diagnosis of skin cancer.
The growing and aging of the world population [1, 2] is associated with an increase of aging-related skin conditions and cutaneous diseases . One of the most distressing and especially in elderly patients fatal skin disease, is skin cancer . There are two types of primary skin cancer, developing within the epidermis: melanoma and non-melanoma skin cancer (NMSC) . Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) are referred to NMSC. In addition, actinic keratosis (AK), also known as solar keratosis is characterized by atypical epidermal keratinocytes, represents a preinvasive “in-situ” lesion of SCC .
Nearly every fifth nursing home resident was affected by actinic keratosis. Our results indicate an association between male sex and actinic keratosis and an association between female sex and NMSC. Previous smoking seems to be associated with an increased incidence of NMSC. Malignant melanoma does not seem to be a frequently occurring tumor in the elderly and very elderly residents living in the institutional long-term care facilities at this age. However, 7.2% of the residents were affected by NMSC. Allied healthcare professionals should play a more important role to deliver dermatological care and to prevent progression from in situ carcinoma (AK) to squamous cell carcinoma.