Skin cancers

Distinct differences in younger and older Mohs patients


Younger people under age 40 with skin cancers requiring Mohs micrographic surgery (MMS) have different patient and tumour characteristics than older patients which will influence their management.

A retrospective review of 493 MMS cases under 40 years attending the Skin and Cancer Foundation Australia/The Skin Hospital in Sydney between 2012 and 2017 found younger patients were more likely to be female in comparison to an older group of patients (63% v 47.5%; p<0.001).

Younger patients were also more likely to have BCCs (95% v 89%), particularly superficial BCCs (9% v 3%), and fewer SCCs than older patients (5% v 11%).

Lesions on younger patients were more often found on the forehead (22.5% v 9.5%) and scalp (9.5% v 4.5%) but less often on the nose compared to older patients (22.5% v 42.5%).

Tumour size overall was not significantly different between the two groups.

However, “When we stratified by site, tumors around the eye and on the nose (p < .001) were both statistically significantly smaller (p < .001) in patients under 40 years compared with controls.”

“There was a statistically significant difference between the groups for number of surgical stages (p = .039) and sections (p = .048), with patients under 40 years requiring fewer of both. In addition, patients under 40 years had significantly smaller final defects (p < .001).”

Patients under 40 years were also more likely to have a side-to-side closure than older patients (43% vs 30%), and less likely to have a flap repair (28% vs 42%).

Senior author on the paper Professor Pablo Fernandez-Penas told the limbic the information would particularly help Mohs surgeons in planning their list.

For example, younger patients, their tumour type and site of lesions meant less complex closures, less surgical time and less surgical risk.

“But if your population is older, you will need to plan more in advance the type of surgery you might have to do.”

He said the fact that the two age groups were so different, suggested the reasons for their skin cancers may also be different.

Genetic factors, for example, may play a larger role in younger patients.

“As the population ages and MMS workforce and scope continues to grow in Australia, it is possible that these differences may become even more apparent over time,” the study concluded.

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