Skin cancer in elderly patients

The role of the dermatologist who provides care to the geriatric patient assumes the care for the integument system. The ability to diagnose and treat cancerous lesions effectively with special care given to the needs of the geriatric patient is considered indispensable. The clinician should accept the responsibility of skin cancers and obtain biopsies with empathy and care.     

Skin infections in the elderly

The diagnosis and management of viral diseases of the skin are significant issues in the elderly population. With advances in these areas, there are new tools to combat these diseases and limit morbidity. It is important for clinicians to monitor and treat these diseases aggressively in the elderly because of the potential for immunosuppression in this population. Further advances in antiviral therapy and the potential for the development of antiviral vaccines will aid in the therapy of these diseases. Onychomycosis is found more frequently in the elderly. In this population, the most common clinical presentations are distal and lateral subungual onychomycosis (which usually affects the great or first toe) and white superficial onychomycosis (which generally involves the third or fourth toes). Over the past several years, new treatments for this disorder have emerged that offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria, such as MRSA and drug-resistant pneumococci. Although vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw a rise in vancomycin-resistant bacteria, including VRE. With treatment options limited, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin-dalfopristin.     

Skin diseases of the lower extremities in the elderly

Routine care of the legs and feet in the elderly is important in helping to prevent infections, malignancies, and further deterioration. The lower extremities are of particular interest because of the increasing amount of diseases and disorders involving the legs and feet. Foot disorders in the elderly are associated with poor choices in footwear, structural changes, brought on by aging, and inadequate knowledge about prevention and treatment. Conservative treatments along with gait modification provide positive long-term results, although sometimes surgery is necessary for severe foot disorders. Onychomycosis and other nail disorders commonly infect the elderly despite the wide variety of treatment options. The increase in malignancy formation in the elderly is caused by the increase in the elderly population and inadequate treatment of leg ulcers and other chronic lesions. Aging is associated with many dermatologic changes; many of the disorders and diseases of the lower extremities can be managed if detected and treated early. Proper awareness of the signs, symptoms, and care is important.     

Skin cancer prevention

Prevention signifies the avoidance of diseases. It also includes the early detection of diseases and taking measures to avoid worsening of an existing disease. Prevention is divided into primary, secondary and tertiary prevention. The prevention of skin cancer is particularly important due to the rising incidence of skin cancer in recent years. In Germany, 195.000 new cases of skin cancer, including non melanoma skin cancer and melanoma are occurring. Therefore, skin cancer is among the most common cancer diseases. Primary prevention comprises the reduction of skin cancer risk behavior, including education about the danger of UV exposure and the right way of dealing with natural and artificial UV radiation. The implementation of a systematic skin cancer screening in Germany contributes to secondary prevention. First data from the initial project in Schleswig‐Holstein, Germanyís most northern state, indicate for the first time that the incidence and mortality of melanoma can be reduced by secondary prevention. For tertiary prevention, the national associations recommend a risk‐adapted, evidence‐based follow‐up for all types of skin cancer. From the perspectives of the payers and from the patients, prevention is assessed positively. Prevention can contribute to a reduction of disease burden.     

Skin cancer prevention in Australia

Australia has one of the highest skin cancer incidence and mortality rates in the world. The reason for these high rates is due in part to the high ambient UV radiation levels, combined with a predominantly susceptible fair-skinned population. To address this problem, since 1980 Australians have been exposed to social marketing campaigns to raise awareness of skin cancer prevention. These campaigns have used mass media alongside interventions in schools, workplaces, and in community and leisure settings to motivate sun protective behaviour. As a result of these interventions it can be demonstrated that social marketing campaigns can be a very effective method to not only motivate behaviour change, reduce sunburn, and increase awareness but more importantly, reduce melanoma rates and bring positive economic returns to government. However long term investment in this area is required otherwise any population gains in behaviour are very likely to be quickly eroded.     

Skin metastases in cancer patients

Although every cancer may cause skin metastases, some do so more frequently. Proper diagnosis can lead to early detection of a previously unrecognized malignancy. Autopsy data from 7,518 patients with internal cancer were analyzed, and the findings were compared with the literature.     

Skin cancer in blacks in the United States

Skin cancer is rare in blacks compared with whites in the United States. The most common form is squamous-cell carcinoma, not basal-cell carcinoma, as it is in whites. Sunlight does not appear to be an important etiologic factor in skin cancer in blacks, as most lesions occur on covered areas. Malignant melanoma is low in frequency but commonly affects acral areas and has a poor prognosis. Mycosis fungoides and dermatofibrosarcoma protuberans appear to have a high frequency among skin cancers. Squamous-cell carcinoma, malignant melanoma, and mycosis fungoides have a relatively high mortality rate in blacks. Bowen's disease and Kaposi's sarcoma occur in blacks but are rare. As there is a high frequency of squamous-cell carcinoma of the skin in blacks, prevention and early detection should benefit the patient. Considering the difficulties encountered in applying epidemiologic methods to skin cancer on a national scale, etiologic studies should be conducted in carefully selected areas. Future investigations of skin cancer in blacks should include an examination of risk factors such as burns, trauma, and diet and familial and immunologic aspects as well.