Due to demographic change, the number of squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) on face increases by 10 % per year. Parallel to this , the proportion od elderly patients is increasing. The operation ist the method of choice for this tumour localization. Is the surgery also suitable for 85+ patients or is the drug therapy with Vismodegib or PD1-antibodies the better option. 19,6 % (n=94) of 481 patients from 1.1.2018 to 30.6.2019 in our hospital were between 85 and 97 years old (average age 88,7 years). In addition to the tumour resection, a regional flap plasticwas applied in 62 %, in 26 % in a dilated plastic and in 11 % in a defect closure by split skin transplantation. The necrosis risk was slightly higher at 3,7 % than in younger patients. Only 3 patients received ultima ratio Vismodegib. Irrespective of high price Vismodegib per os could not meet expectations in this age group.The toxicity should not be underestimated especially in elderly patients. Surgical therapy remains the gold standard for the time being. Multimorbidity and dementia are not contraindications for skin surgery in very elderly patients. Discontinuation of therapy is not an option of the progressive tumour growth with ulcerations.
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