Dermatologic surgery in elderly patients with limited life expectancy: Ethical considerations

An aging population has introduced increased complexity into dermatologic care, particularly among older adults with significant comorbidities, functional dependence, cognitive decline, and competing health priorities. Simultaneously, nonmelanoma skin cancers are among the most common malignancies affecting this population. Although dermatologic surgery often yields excellent oncologic outcomes, the appropriateness of definitive intervention becomes ethically complex when tumor behavior, patient prognosis (life expectancy), procedural burden, and patient preferences are not fully aligned. Low-risk basal cell carcinomas may demonstrate slow growth and limited morbidity over the course of a patient's remaining lifespan, complicating decisions about whether invasive treatment is proportionate to the anticipated benefit. Although respect for patient autonomy is fundamental, the principle requires informed decision making that incorporates prognosis, other medical priorities, procedural risks, postoperative burden, and quality-of-life considerations. Additional ethical tensions arise regarding nonmaleficence, distributive justice, appropriate use of limited health care resources, caregiver burden, and decisional capacity of cognitively impaired patients. Treatment decisions should remain individualized and grounded in transparent discussion of prognosis, quality of life, functional status, and procedural burden. In older adults with limited longevity, ethical dermatologic care necessitates balancing oncologic benefit with the broader realities of the patient's overall health and well being.