P081 Clinical frailty predicts both lifetime burden and active presentation of keratinocyte cancer: a cohort study

Abstract

The relationship between physiological frailty and skin carcinogenesis is poorly understood. While age is a known risk factor, it is unclear whether frailty independently contributes to skin cancer risk or merely reflects chronological ageing. This study aimed to investigate the association between frailty as defined by the Clinical Frailty Score (CFS) and skin cancer burden. Following ethical approval, patients ≥ 50 years old were recruited from dermatology skin cancer clinics (including new referrals and follow-up patients) during July to October 2025. Frailty was assessed with the Rockwood Clinical Frailty Scale, categorized as ‘fit’ (CFS 1–3) or ‘frail’ (CFS ≥ 4). Histopathology records were accessed and demographic details recorded. Multivariate logistic regression analyses, adjusted for age, were used to investigate the association between frailty and total history of skin cancer (lifetime burden) and the association between frailty and new skin cancer diagnosis at current presentation (current clinic). In total, 220 patients (123 male) were recruited. The age range was 50–95 years (median 77, interquartile range 69–83). Overall, 140 (63.6%) were ‘fit’, and 80 (36.4%) were ‘frail’. In total, 131 patients presented with a current keratinocyte cancer (KC), 33 with melanoma and 56 with no skin cancer. Analysing lifetime burden, frail patients had significantly higher odds of a history of KC [odds ratio (OR) 5.76, 95% confidence interval (CI) 2.16–15.3, P < 0.001] compared with controls. In the current clinic, the association was similar: frailty strongly predicted new diagnosis of KC (OR 5.41 95% CI 2.23–13.1, P < 0.001) compared with controls. No statistically significant association was found for melanoma (OR 3.30, P = 0.08). Clinical frailty (CFS ≥ 4) was a strong predictor of both the cumulative history and active presentation of KC, independently of age. This pilot study supports integrating frailty assessment into keratinocyte cancer clinics to identify high-risk frail patients.