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Objectives  To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma ( KC ), the most common malignancy and the fifth most costly cancer to Medicare.    Design  Nationally representative cross‐sectional study.    Setting  Nationally representative Health and Retirement Study linked to Medicare claims.    Participants  Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.    Measurements  Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living ( ADL ), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery ( MMS ) (most intensive, highest cost), excision, or electrodesiccation and curettage ( ED &C) (least intensive, lowest cost)), according to procedure code.    Results  Most  KC s (61%) were treated surgically. Rates of  MMS  (19%), excision (42%), and  ED &C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in  ADL s, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent  MMS ; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.    Conclusion  A one‐size‐fits‐all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for  KC , a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.

Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions?