Dermatologic surgery in geriatric patients: Psychosocial considerations and perioperative decision-making

BACKGROUND. Dermatologic surgery, both for cutaneous malignancies and for management of the visible signs of photo-damage, is frequently performed on older persons. OBJECTIVE. To review common psychologic and physiologic limitations among the elderly that may affect their ability to tolerate cutaneous surgery and to outline a stepwise approach for management of these conditions during the perioperative period. METHODS. Literature review, MEDLINE (1966-2001) search, and personal experience. RESULTS. Communication with patients, their families, and their physicians, management of patients' underlying medical problems, and special sensitivity to patients' cognitive and physiologic limitations can minimize perioperative risk during cutaneous surgery in the elderly. CONCLUSION. Given appropriate physician management, elderly patients can usually safely undergo cutaneous surgery.