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Comment & Response
December 9/23, 2013

Treatment of Nonmelanoma Skin Cancer

Author Affiliations
  • 1Department of Dermatology, University of Alabama at Birmingham School of Medicine, Birmingham
JAMA Intern Med. 2013;173(22):2096-2097. doi:10.1001/jamainternmed.2013.10442

To the Editor Linos and colleagues1 inappropriately bundle elderly patients and patients with multiple comorbidities, urging clinicians to encourage patients with limited life expectancy (LLE) to choose nonsurgical treatment modalities for the treatment of nonmelanoma skin cancer (NMSC). As a group, patients older than 85 years may have limited life expectancy, but age alone does not separate those who will experience a quality-of-life (QOL) benefit from those who will not. The best predictor of posttreatment health-related QOL in an otherwise healthy 85-year-old patient is his or her pretreatment skin and health-related QOL.2 Linos et al1 use a nonvalidated survey to measure how bothered the patients are by their NMSC, failing to include tumors that are moderately bothersome. Furthermore, the author trivializes the patients’ perception of their skin cancer, stating that they are “low impact.”1 Previous work by Chen et al2 has demonstrated that among symptoms, emotional effects, and effects on functioning, emotional effects had the greatest impact on QOL for patients with NMSC. Although rarely fatal, NMSCs are cancer, and elderly but otherwise healthy patients of any age can experience a great deal of distress leaving skin cancer untreated.3 In addition, Linos et al1 argue that patients are unlikely to survive long enough to receive a benefit even when the majority of the patients in their study lived beyond 5 years.1 Not only do these statements mislead the reader, the author fails to acknowledge that the QOL benefits of treating NMSC can be measured at 12 months.2