Cutaneous Squamous Cell Carcinoma in Very Elderly Patients: An Observational Analysis From 90 Years of Age Onward

Although the incidence rate of cutaneous squamous cell carcinoma (cSCC) increases with age, there is limited information on the comprehensive evaluation of very elderly patients. This study aimed to describe the clinicopathological characteristics of patients aged≥90 years with cSCC and to review the available literature.

We conducted a retrospective study of patients aged≥90 years with histologically confirmed cSCC, evaluated from 2020 to 2024 by a multidisciplinary committee in a tertiary referral center. Frailty was determined through comprehensive geriatric assessment.

A total of 29 patients were included (mean age, 94.4 years). The median diagnostic delay was 4 months (IQR, 3-12), and follow-up was 12.5 months (IQR, 6-15). During follow-up, 51.7% of patients died. A total of 69% were categorized as Frailty Group 3. A total of 95.7% met high-risk cSCC criteria. Initial surgical treatment was performed in 86.2%; radiotherapy was the adjuvant therapy in 10.3% and palliative care in 13.7%. The recurrence rate was 13.8%. A total of 39.4% were taking medications associated with cSCC development, particularly antihypertensives. The 12-month survival probability was 63.6%.

Patients aged≥90 years with cSCC showed relatively favorable survival. Despite the conservative approach often adopted in this age group, based on presumed therapeutic inadequacy due to age and comorbidities, our findings and the available literature support a proactive therapeutic approach. This should be based on multidisciplinary and individualized assessment.