Surgery may not be the best decision for older, sicker patients who have non-melanoma skin cancers, a new study suggests.

Researchers from the University of California at San Francisco (UCSF) followed more than 1,300 patients who had non-melanoma skin cancer for about a decade. About a quarter of the patients were classified as having limited life expectancy because they were at least 85 years old or had multiple serious health conditions.

In the study, most of the non-melanoma skin cancers were treated surgically. One in five patients reported a complication from the treatment, including poor wound healing, numbness, itching, and pain. Tumor recurrence was less than 4% after 5 years. Approximately half the patients with limited life expectancy died of other causes within 5 years.

The study appears online in JAMA Internal Medicine.

To Treat or Not to Treat Non-Melanoma in Older, Sicker Adults?

“It can be very challenging to decide whether and how to treat patients with non-melanoma skin cancer who have limited life expectancy, especially when the tumors are asymptomatic,” said study author Eleni Linos, MD, DrPH, an assistant professor of dermatology at UCSF, in a press release. “One challenge is that it is hard to precisely predict an individual’s life expectancy.”eleni

Additionally, elderly patients are very diverse. “For example, some 90-year-olds are active, healthy, and would like to choose the most aggressive treatments for skin cancer, while others are very frail and unable to care for themselves, and may prefer less invasive management for a skin cancer that doesn’t bother them,” she said. “Bothersome or medically dangerous skin tumors should always be treated, regardless of age or life expectancy, [but] treatment of asymptomatic tumors might not be the best option for all patients.”