Validation of a novel scoring system for skin frailty and its association with age and skin cancer

Summary: Abstract Body: Skin frailty is characterized by the decline in the skin’s protective mechanisms due to both internal and external factors. A validated assessment tool incorporating clinical signs of skin frailty is currently lacking. Following Stanford Human Subjects’ Panel approval and written informed consent, we developed and validated a scoring system to assess skin frailty. Two dermatologist raters assessed digital photographs from 238 adult participants, identifying five reliable skin frailty parameters—purpura, hyperpigmentation, wrinkles, sagging, and skin integrity breakdown—using a 4-point Likert scale, with all parameters demonstrating reliability (Kendall coefficient or Gwet’s AC2 > 0.8) both between and within raters. The total skin frailty score (SFS), the sum of the above five parameters, also showed strong reliability (intraclass correlation coefficient = 0.75 for inter-rater, 0.86 for intra-rater). The average SFS (as assessed by two raters, two rounds each) correlated positively with age (Spearman’s Rho = 0.74) and was higher in participants with skin cancer history (median 4.00 vs. 2.25, Mann-Whitney U test, p < 0.001). Linear regression models identified age, female gender, and skin cancer history as significant independent predictors of higher SFS (beta coefficients 0.13, 0.75, and 0.58, respectively, all p < 0.05). The numbers of melanoma and non-melanoma skin cancers were also significantly correlated with SFS (beta coefficients 0.12 and 0.11, respectively, both p < 0.05). Logistic regression with skin cancer as the dependent variable showed that higher SFS quartiles were associated with significantly increased odds of skin cancer. Compared to individuals in the first quartile (0 ≤ SFS < 2.25), second (2.25 ≤ SFS < 3.50), third (3.50 ≤ SFS < 5.50), and fourth (SFS ≥ 5.50) quartiles had respectively 5, 4, and 10 times skin cancer odds (all p < 0.05). Our scoring system provides a validated and reliable method for assessing skin frailty and may serve as a valuable tool for evaluating skin cancer risk. Po-Han Ho¹, Farah Abou-Taleb¹, Shufeng Li¹, Vijaytha Muralidharan¹, Kiana Yekrang¹, Albert S. Chiou¹, Anne Lynn S. Chang¹ 1. Dermatology, Stanford University School of Medicine, Stanford, CA, United States. Clinical Research: Epidemiology and Observational Research