Actinic keratosis and squamous cell carcinoma of the elderly

Actinic keratosis and squamous cell carcinoma in the elderly. The increase in life expectancy and the change in the habits of the population with respect to UV exposure have led to an increase in the incidence of actinic keratosis (AK) and squamous cell carcinoma (SCC). There is no specific recommendation for the "frail" elderly, but they would not differ much from the recommendations of the younger subjects. AK are common: 1 in 3 men and 1 in 5 women after 70 years. In the absence of treatment, the AK can evolve towards a SCC, justifying the interest of a systematic and early management of the AK by cryotherapy (liquid nitrogen), dynamic phototherapy, cream containing 5-fluorouracil (5(FU), imiquimod or ingenuous mebutate. Incidence of SCC is also important in the elderly and especially in mans. It can be localized on skin or mucosa. There are forms of SCC in situ or Bowen disease, cutaneous or mucosal, accessible to cryotherapy, 5-FU, imiquimod or dynamic phototherapy as an alternative to surgery. The SCC presents a mainly local evolutionary risk, with involvement of adjacent noble organs, but also regional, with significant risk of lymph node metastases, and visceral (lungs, liver in particular). The treatment must be supervised by a multidisciplinary team. If the patient has cognitive disorders, the presence of the "person of trust" is possible. At best the presence of a geriatrician or onco-geriatrician is recommended. Most often active treatment will be considered and surgical excision is the standard treatment. If general anesthesia is required, the limitation may be at this time of management because of significant co-morbidities. For inoperable SCC radiotherapy and radiochemotherapy are sometimes proposed. Metastatic SCC is complex in elderly patients because chemotherapy is poorly tolerated.