Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients

Balch, Charles M.; Thompson, John F.; Gershenwald, Jeffrey E.; Soong, Seng Jaw; Ding, Shuo; McMasters, Kelly M.; Coit, Daniel G.; Eggermont, Alexander M.M.; Gimotty, Phyllis A.; Johnson, Timothy M.; Kirkwood, John M.; Leong, Stanley P. L.; Ross, Merrick I.; Byrd, David R.; Cochran, Alistair J.; Mihm, Martín C.; Morton, Donald L.; Atkins, Michael B.; Flaherty, Keith T.; Sondak, Vernon K.

doi:10.1245/s10434-013-3464-x

Cited by 137 publications

(99 citation statements)

References 47 publications

(34 reference statements)

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“…Various melanoma studies have demonstrated that patient age is an independent prognostic factor for survival (3)(4)(5)(6). It has been established in patients with early stage primary melanoma that older patients have more unfavorable clinicopathological features, such as the melanoma is thicker, ulcerated and has a higher mitotic rate (3)(4)(5)(6).…”

Section: Discussionmentioning

confidence: 99%

“…It has been established in patients with early stage primary melanoma that older patients have more unfavorable clinicopathological features, such as the melanoma is thicker, ulcerated and has a higher mitotic rate (3)(4)(5)(6). A large analysis of 17,600 patients with melanoma demonstrated that older patients had more advanced primary tumors, and that older age was correlated with lower melanoma survival (3).…”

Section: Discussionmentioning

confidence: 99%

“…However, notably, this detrimental outcome occurred although these patients had a lower rate of lymph node metastasis compared with the other age groups in the investigations (4,(6)(7)(8)(9). Thus, melanomas in patients of different ages, among older and younger patients, have different biological characteristics in large datasets (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 91%

“…The impact of patient age has been reported as a highly significant and strong predictor of outcome in patients with cutaneous melanoma (3)(4)(5)(6)(7)(8)(9). Elderly patients with melanoma have been associated with a higher mortality rate than other age groups because they had the most aggressive prognostic features of the primary melanomas, including thicker depth, higher mitotic rates and increased likelihood of ulceration (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…Elderly patients with melanoma have been associated with a higher mortality rate than other age groups because they had the most aggressive prognostic features of the primary melanomas, including thicker depth, higher mitotic rates and increased likelihood of ulceration (3)(4)(5)(6). However, notably, this detrimental outcome occurred although these patients had a lower rate of lymph node metastasis compared with the other age groups in the investigations (4,(6)(7)(8)(9). Thus, melanomas in patients of different ages, among older and younger patients, have different biological characteristics in large datasets (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

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Patient age and cutaneous malignant melanoma: Elderly patients are likely to have more aggressive histological features and poorer survival

Taş

Ertürk

2017

mol clin onc

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Abstract. Patient age has been reported as a highly significant and strong predictor of the outcome in patients with cutaneous melanoma. The aim of the present study was to determine the clinical significance of patient age in Turkish patients with cutaneous melanoma. A total of 1,169 patients with pathologically proven cutaneous melanoma were enrolled. Age of patients was classified as young (<40 years), middle-aged (40-59 years) and old (≥60 years). The median age of the patients was 51 years (range, 16-104 years). Non-superficial spreading histology was significantly more observed in old patients than in the other age groups (P<0.001). A lower Clark invasion level was significantly more observed in young patients compared with the other age groups (P= 0.013) and higher levels were significantly more observed in older patients compared with the other age groups (P=0.002). Furthermore, the rate of thin Breslow depth was significantly higher in young patients compared with others (P=0.038). Although a lower mitotic rate was observed predominantly in young patients compared with others (P= 0.007), ulceration was significantly more present in older patients (P<0.001) and absent in the young patients (P= 0.003). Patient age was not significantly associated with relapse-free survival (P=0.327), whereas a significant correlation was demonstrated for overall survival (OS) (P= 0.007). The old patients had poorer survival compared with the other ages (P=0.009 for young patients and P=0.012 for middle-aged patients). However, patient age did not remain significant for OS in multivariate analysis (P=0.768). In conclusion, although patient age does not have a significant predictive role on nodal involvement, recurrence and metastasis, an age of ≥60 years may be associated with more aggressive histological features and poorer outcome in patients with cutaneous melanoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Patient age and cutaneous malignant melanoma: Elderly patients are likely to have more aggressive histological features and poorer survival

Taş

Ertürk

2017

mol clin onc

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Association Between Patient Age and Lymph Node Positivity in Thin Melanoma

et al. 2017

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IMPORTANCE More than half of all new melanoma diagnoses present as clinically localized T1 melanoma, yet sentinel lymph node biopsy (SLNB) is controversial in this population given the overall low yield. Guidelines for SLNB have focused on pathologic factors, but patient factors, such as age, are not routinely considered.OBJECTIVES To identify indicators of lymph node (LN) metastasis in thin melanoma in a large, generalizable data set and to evaluate the association between patient age and LN positivity. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study using the National Cancer Database, an oncology database representing patients from more than 1500 hospitals throughout the United States, was performed (2010)(2011)(2012)(2013). Data analysis was conducted from October 1, 2016, to January 15, 2017. A total of 8772 patients with clinical stage I 0.50 to 1.0 mm thin melanoma undergoing wide excision and surgical evaluation of regional LNs were included for study. MAIN OUTCOME AND MEASURESThe primary outcome of interest was presence of melanoma in a biopsied regional LN. Clinicopathologic factors associated with LN positivity were characterized, using logistic regression. Age was categorized as younger than 40 years, 40 to 64 years, and 65 years or older for multivariable analysis. Classification tree analysis was performed to identify high-risk groups for LN positivity.RESULTS Among the study cohort (n = 8772), 333 patients had nodal metastases, for an overall positivity rate of 3.8% (95% CI, 3.4%-4.2%). A total of 4087 (54.0%) patients were women. Median age was 56 years (interquartile range [IQR], 46-67) in patients with negative LNs and 52 years (IQR, 41-61) in those with positive LNs (P < .001). In multivariable analysis, younger age, female sex, thickness of 0.76 mm or larger, increasing Clark level, mitoses, ulceration, and lymphovascular invasion were independently associated with LN positivity. In decision tree analysis, patient age was identified as an important risk stratifier for LN metastases, after mitoses and thickness. Patients younger than 40 years with category T1b tumors 0.50 to 0.75 mm, who would generally not be recommended for SLNB, had an LN positivity rate of 5.6% (95% CI, 3.3%-8.6%); conversely, patients 65 years or older with T1b tumors 0.76 mm or larger, who would generally be recommended for SLNB, had an LN positivity rate of only 3.9% (95% CI, 2.7%-5.3%). CONCLUSIONS AND RELEVANCEPatient age is an important factor in estimating lymph node positivity in thin melanoma independent of traditional pathologic factors. Age therefore should be taken into consideration when selecting patients for nodal biopsy.

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The Changing Kinetics of Advanced Melanoma

Coit

2019

JAMA Dermatol

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The current issue of JAMA Dermatology contains 3 articles that attempt to describe some aspect of disease kinetics of selected subsets of patients with melanoma.The first of these studies, from von Schuckmann and colleagues 1 in Australia, attempts to describe factors predictive of early recurrence (within 2 years) among patients who presented for treatment of clinically localized T1b to T4b melanoma in Queensland.Patients were recruited prospectively from a number of hospital and private clinic sources. Of 1245 patients identified and invited to participate, 700 (56%) were included in the analysis. Most of the follow-up was obtained as a patient-reported binary recurrence status (yes/no) every 6 months. In the event of patients lost to follow-up, local hospital records and Queensland Cancer Registry data were reviewed. All recurrences were verified insofar as possible by medical record review. Factors identified predicting recurrence within 2 years were not surprising and included the presence of ulceration, an increased mitotic index, increasing T stage, and head and neck location. Descriptive statistics were provided comparing outcomes by the seventh and eighth editions of the AJCC Staging Manual, and describing the initial sites of recurrence.The biggest challenge in interpreting the significance of this study is the heterogeneity of the patient data set, a data set that included 442 patients with clinical T1b to T4b who did not undergo sentinel lymph node biopsy (SLNB), 213 patients with pathologic T1b to T4b who had a negative SLNB result, and 38 patients with at least stage IIIa after a positive SLNB result (the SLNB numbers do not quite add up to 700 in Table 1). This heterogeneity recalls that of the AJCC7 data set, where pathologic staging of clinically localized melanomas was not required. The A JCC8 has addressed this shortcoming by including only patients who underwent SLNB, 2 thus describing more homogeneous T-stage subsets. Excluding the patients with T1a disease, the AJCC8 data set depicted describes the dynamic kinetics of outcome in 10 466 patients with pathologic T1b to T4b melanomas. As expected, more advanced tumors generally recur more frequently and earlier. Importantly, the AJCC8 data set demonstrated that most events in this cohort of patients are expected to occur after the 2-year threshold described in the study by von Schuckmann et al, 1 with continued attrition out to at least 10 years. Thus, the second concern: the 2-year interval, although entirely practical for a prospective study such as this, may not be entirely reflective of the true biology of this heterogeneous cohort.

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Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients

Cited by 137 publications

References 47 publications

Patient age and cutaneous malignant melanoma: Elderly patients are likely to have more aggressive histological features and poorer survival

Patient age and cutaneous malignant melanoma: Elderly patients are likely to have more aggressive histological features and poorer survival

Association Between Patient Age and Lymph Node Positivity in Thin Melanoma

The Changing Kinetics of Advanced Melanoma

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