Age‐related characteristics of cutaneous melanoma in a <scp>S</scp>panish <scp>M</scp>editerranean population

Montero, Iria; Requena, Celia; Traves, Víctor; García-Casado, Zaida; Kumar, Rajiv; Nagore, Eduardo

doi:10.1111/ijd.12496

Cited by 14 publications

(15 citation statements)

References 34 publications

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“…Our SEER analysis shows that with increasing age, primary melanomas exhibit increased thickness and more unfavorable pathologic features, leading to more advanced stages, increased mortality, and worse MSS, independent of gender and stage at diagnosis. This validates an analysis of 13,581 patients in the AJCC melanoma database in which age was the third most significant prognostic factor for localized melanomas after thickness and ulceration [ 28 – 30 ].…”

Section: Discussionsupporting

confidence: 77%

Impact of aging on host immune response and survival in melanoma: an analysis of 3 patient cohorts

et al. 2016

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BackgroundAge has been reported as an independent prognostic factor for melanoma-specific survival (MSS). We tested the hypothesis that age impacts the host anti-tumor immune response, accounting for age-specific survival outcomes in three unique melanoma patient cohorts.MethodsWe queried the U.S. population-based Surveillance, Epidemiology, and End Results Program (SEER), the prospective tertiary care hospital-based Interdisciplinary Melanoma Cooperative Group (IMCG) biorepository, and the Cancer Genome Atlas (TCGA) biospecimen database to test the association of patient age at time of melanoma diagnosis with clinicopathologic features and survival outcomes. Age groups were defined as ≤45 (young), 46–65 (intermediate), and >65 (older). Each age group in the IMCG and TCGA cohorts was stratified by tumor infiltrating lymphocyte (TIL) measurements and tested for association with MSS. Differential expression of 594 immunoregulatory genes was assessed in a subset of primary melanomas in the IMCG and TCGA cohorts using an integrative pathway analysis.ResultsWe analyzed 304, 476 (SEER), 1241 (IMCG), and 292 (TCGA) patients. Increasing age at melanoma diagnosis in both the SEER and IMCG cohorts demonstrated a positive correlation with tumor thickness, ulceration, stage, and mortality, however age in the TCGA cohort did not correlate with mortality. Older age was associated with shorter MSS in all three cohorts. When the young age group in both the IMCG and TCGA cohorts was stratified by TIL status, there were no differences in MSS. However, older IMCG patients with brisk TILs and intermediate aged TCGA patients with high lymphocyte scores (3–6) had improved MSS. Gene expression analysis revealed top pathways (T cell trafficking, communication, and differentiation) and top upstream regulators (CD3, CD28, IFNG, and STAT3) that significantly changed with age in 84 IMCG and 43 TCGA primary melanomas.ConclusionsOlder age at time of melanoma diagnosis is associated with shorter MSS, however age’s association with clinicopathologic features is dependent upon specific characteristics of the study population. TIL as a read-out of the host immune response may have greater prognostic impact in patients older than age 45. Recognition of age-related factors negatively impacting host immune responses may provide new insights into therapeutic strategies for the elderly.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-016-1026-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 77%

Impact of aging on host immune response and survival in melanoma: an analysis of 3 patient cohorts

et al. 2016

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“…We hypothesize this observation could be due to either a site-specific higher melanocyte proliferation, to the influence of greater sun exposure at this area, or due to a combination of both factors. The strong link between nevus density, primary melanoma site and a prior history of sunburn or intermittent UVR exposure at the same site support the role of sun exposure as a trigger for melanoma development in an already predisposed area [ 30 – 32 ]. The present findings suggest that areas with a high nevus density that have suffered mild or intense sunburns should be clinically examined more carefully, and should probably need to be more meticulously sun protected in order to prevent the increase in the number of nevi, an approach which has been proven especially useful in fair-skinned, freckle-prone patients [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Cutaneous melanoma primary site is linked to nevus density

et al. 2017

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There are at least two pathways driving cutaneous melanoma; one is linked to an inherent melanoma susceptibility to nevi development and the second to environmental cumulative ultraviolet light exposure. In this study, we examined the relation between nevus density, accrued sun damage and the site of primary melanoma excision.In a series of 888 consecutive cutaneous melanoma patients, melanomas appearing in skin areas with a high relative nevus density were most prominent in men, with an elevated nevus count, at sites without solar elastosis, but with an epidemiological history of previous sunburn.The present study associates melanoma development to sites with high nevus density. Our study supports more careful surveillance of body areas with increased nevus density in patients with high total body number of nevi, especially when they report a history of sunburns at these sites.

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“…3,8 Although numerous risk factors have been associated to the development of MM (including light eyes and low skin phototypes, presence of dysplastic naevi, tendency to freckle and family history of melanoma), the significance of some associations remains unclear, particularly in aged subgroups. [3][4][5] The risk associated with sun exposure and multiple naevi, for example, are controversial.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The risk associated with sun exposure and multiple naevi, for example, are controversial. 8,9 Traditional prognostic factors for cutaneous MM include thickness, ulceration, mitoses/mm 2 , clinical stage, anatomic location, sex and age, 10 and although some pathologic features were previously linked to lower disease specific survival rates, 4,5,7,10 some associations remain uncertain in older patients. 10 In accordance to our findings, several studies suggested that melanoma is more common in older men; 3,4,6-8,10 they have focused on histologic features and/or survival, and few evaluated risk factors for melanoma.…”

Section: Discussionmentioning

confidence: 99%

“…10 In accordance to our findings, several studies suggested that melanoma is more common in older men; 3,4,6-8,10 they have focused on histologic features and/or survival, and few evaluated risk factors for melanoma. 3,5,7,8 MacDonald et al 7 found that melanoma was less likely to arise from a pre-existing naevi in patients older than 70 years. Although multiple naevi is a powerful predictive phenotypic marker for melanoma development, nevi usually involute after the 40 th decade; therefore, they are much less numerous in older patients, 9 thus explaining why we found significantly less elderly with more than 50 naevi.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and pathological melanoma differences in young and old people

Wachholz¹,

Masuda²,

Pinto³

2017

Geriatr., Gerontol. Aging

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Age‐related characteristics of cutaneous melanoma in a Spanish Mediterranean population

Abstract: Our results suggest that melanoma development in younger patients is the result of genetic factors, particularly related to multiple nevi, whereas in older patients environmental factors such as severe chronic sun exposure play a major role.

Cited by 14 publications

References 34 publications

Impact of aging on host immune response and survival in melanoma: an analysis of 3 patient cohorts

Impact of aging on host immune response and survival in melanoma: an analysis of 3 patient cohorts

Cutaneous melanoma primary site is linked to nevus density

Clinical and pathological melanoma differences in young and old people

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