Barriers to dermatologic care for geriatric patients who received extensive Mohs surgery - an in-depth qualitative analysis

Abstract Two to three million new cases of skin cancer are diagnosed annually in patients over the age of 65. Evaluation, diagnosis, and treatment of skin cancer in the geriatric population may be impeded due to various barriers. Diagnostic delay can frequently lead to larger and more complex skin cancers that require treatment with Mohs micrographic surgery (MMS). Our objective was to identify barriers for skin cancer intervention in patients ³65 years of age who have undergone MMS. We performed a qualitative analysis using open-ended, semi-structured interview questions with patients ³65 years of age from Atrium Health Wake Forest Baptist dermatology clinics who underwent non-extensive and extensive MMS. Non-extensive MMS was defined as having two or fewer skin layers removed, while extensive MMS was defined as having three or more skin layers removed. Twelve patients (ages 68-91, 42% female, 100% White, with one to 13 skin layers removed) described barriers to early skin cancer identification and intervention, including poor skin cancer knowledge, individual and systemic factors, and patient-provider relationships. Early education, direct and consistent communication, and personal provider-patient relationships may be beneficial in preventing the progression of skin cancers in the geriatric patient population and subsequent extensive MMS.