Surgery for head and neck skin tumors in the elderly

Our aim was to determine the surgical characteristics of an elderly cohort of patients undergoing resection of head and neck skin neoplasms. METHODS.: All cases of patients with head and neck skin neoplasms (excluding malignant melanoma) who underwent surgical resection in a regional referral center over a 10-year period were retrospectively reviewed. The study group comprised 152 patients (208 cases) aged >or=80 years. They were compared with 311 patients (430 cases) aged <80 years.

Elderly patients had higher Charlson comorbidity index, American Society of Anesthesiologists' physical status scores, dementia, and aspirin intake (all p < .05). They also had a higher incidence of scalp involvement and lower incidence of nasal involvement (both p < .05). Elderly patients had a larger lesion size at presentation and required sacrifice of a greater area of skin (both p < .05). However, they also underwent more local anesthetic procedures, although the need for local flap or skin graft repair was not increased. Two elderly patients had intraoperative tachyarrythmias induced by local anesthesia. However, no patient died within 30 days of surgery, and wound complication rate and disease-free survival were comparable to younger patients.

With careful attention to comorbid illness and perioperative monitoring, surgical resection of head and neck skin neoplasms is safe in the elderly. Lesions are more advanced at presentation and hence require sacrifice of a larger area of skin to obtain macroscopic clearance. Yet for the majority of lesions, local anesthesia is adequate and surgical resection and simple skin closure can be accomplished without the need for complex flap or skin graft reconstructions.