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November 13, 1987

Fleeting Wisdom-Reply

Author Affiliations

Pomona Valley Community Hospital Pomona, Calif

Pomona Valley Community Hospital Pomona, Calif

JAMA. 1987;258(18):2527. doi:10.1001/jama.1987.03400180061016

In Reply.—  Both Dr Resneck and Dr Auerbach make valuable suggestions. In particular, Dr Auerbach offers an alternative approach to the treatment of basal cell carcinoma on the face of very old patients, whereas Dr Resneck recounts a valuable, if not horrific, anecdote in counterpoint to my own. In conjunction with the point I attempted to make in my article, the implicit chord sounded in Dr Resneck's letter is the utter lack of standardized approaches to treatment in ancient patients. Of necessity, all suggestions regarding treatment of almost any type in centenarians are subjective and no doubt based in large part on personal observation and opinion.Dr Resneck's experience shows the other side of the coin, the one in which withholding treatment produces dramatically disfiguring results. Certainly the patient, as Dr Resneck maintains, or the patient's guardian in the event of mental incompetency, should have the final word regarding treatment.