DermHelpCentral

About Frailty

Deciding When Older Patients Should have an Operation, by Paula Span, NY Times, October 31, 2017.

Full NY Times Article

In geriatrics, frail is not merely an adjective. A syndrome marked by slowness, weakness, fatigue and often weight loss, frailty tells doctors a lot about their patients’ likely futures. It can, for example, predict how well older patients rebound from physical stresses — like surgery.

The “timed up-and-go,” test measures how long it takes someone to rise from a chair, walk 10 feet, turn around, walk back and sit down again. This is a simple and important test.

A study that Dr. Seib and her colleagues published in JAMA Surgery (October 2017) shows that frailty is associated with increased perioperative morbidity in common ambulatory general surgery operations, independent of age, type of anesthesia, and other comorbidities. Surgeons should consider frailty rather than chronological age when counseling and selecting patients for elective ambulatory surgery.

Even for out-patient surgery, it is important to take frailty into account for any operation, big or small. One should screen for frailty before any procedure.

Here is a free online article from the Journal of Gerontology (11/2015) Frailty in Older Adults: A Nationally Representative Profile in the United States.

Basal Cell Radiotherapy

Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: our experience in 671 lesions.

Caccialanza M et.al Eur Acad Dermatol Venereol. 2009 Sep;23(9):1044-9

J Eur Acad Dermatol Venereol. 2009 Sep;23(9):1044-9.

Abstract

BACKGROUND: The skin overlying the nose cartilage is a particularly frequent localization of skin carcinoma (about 25% of all carcinomas occurring on the head and neck). It is therefore of great practical interest to identify the best therapy, able to combine effectiveness with a good cosmetic and functional result.

OBJECTIVE: To verify both the therapeutic effectiveness of dermatologic radiotherapy and its 'toxicity' in the treatment of a large number of skin carcinomas overlying the cartilage of the nose.

METHODS: A retrospective study was done on 671 basal and squamous cell carcinomas treated by kilovoltage radiotherapy in the period 1972-2007.

RESULTS: The mean follow-up time was 38.016 months (range, 1-351 months). The 5-year cure rate was 88.09%. Cosmetic results were evaluated as 'good' or 'acceptable' in 96.84% of the treated lesions in complete remission. So far, no complication or sequelae to the radiologic treatment have been observed.

CONCLUSION: Dermatologic radiotherapy showed to be a safe, effective and non-invasive method, superior, on the basis of the literature data, to any other available therapeutic modality in the management of basal and squamous cell skin carcinomas localized over the nasal cartilages.

Comment: I think Moh's surgeons would say that their cure rates are higher, but then, this group may include very complex lesions that were not amenable to Moh's or that would have left significant defects.  One would need to review this article carefully. DJE

Self Suture (Stitches) Removal

So...  you don't want to waste time by schlepping to the doctor to have stitches removed.  Good on ya. One reason to go, would be to discuss the biopsy findings.  This is not always important or practical.  Basically, it is a K.I.S.S. procedure (Keep It Super Simple).

I found this helpful two minute video on How To Remove Stitches by Doc Misty.

Keep in mind that suture removal is not a sterile procedure.  Stitches need to stay in for varying times depending on where they are.  If removed too early the wound can open up (dehisce).  If left in too long, the scar may be worse.

Face:  ~ 7 days
Body: ~ 10 days
Hands/Feet - 14 days 

Your doctor can tell you when she recommends to remove the stitches.