Localized melanoma in older patients, the impact of increasing age and comorbid medical conditions

Rees, M.; Liao, Henry; Spillane, John; Speakman, David; McCormack, Christopher; Donahoe, Simon; Pohl, Miklos; Webb, Angela; Gyorki, David E.; Henderson, Michael A.

doi:10.1016/j.ejso.2016.01.010

Cited by 23 publications

(11 citation statements)

References 23 publications

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“…Although age was associated with a general increase in postoperative complications in previous studies with various types of operations, in our study, age was not a risk factor for seroma development. Moreover, analysis of seroma development after SLNB for breast cancer found a correlation between age and seroma development in one study but not in a prospective study .…”

Section: Discussioncontrasting

confidence: 74%

Predicting risk for seroma development after axillary or inguinal sentinel lymph node biopsy in melanoma patients

et al. 2018

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Section: Discussioncontrasting

confidence: 74%

Predicting risk for seroma development after axillary or inguinal sentinel lymph node biopsy in melanoma patients

et al. 2018

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“…Some earlier studies have shown a correlation between comorbidity or performance status and the decision to perform SNB, while others have not 22,25,26. In our study, comorbid conditions were the reason for not performing the procedure in all patients < 65 years of age in whom SNB was omitted.…”

Section: Discussioncontrasting

confidence: 52%

“…Previous research has demonstrated that SNB is readily able to be performed in the older population, and, in the majority of elderly patients, the SN is in fact procured 7,22–26. In our study, 75% of patients aged 75 years or older underwent the procedure, and it was still performed in 47% of those aged 85 years and over.…”

Section: Discussionmentioning

confidence: 50%

Focused Ultrasound Surveillance of Lymph Nodes Following Lymphoscintigraphy Without Sentinel Node Biopsy: A Useful and Safe Strategy in Elderly or Frail Melanoma Patients

et al. 2019

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Background Sentinel node (SN) biopsy (SNB) has become standard of care in clinically localized melanoma patients. Although it is minimally invasive, advanced age and/or comorbidities may render SNB inadvisable in some patients. Focused ultrasound follow-up of SNs identified by preoperative lymphoscintigraphy may be an alternative in these patients. This study examines the outcomes in patients managed in this way at a major melanoma treatment center. Methods All patients with clinically localized cutaneous melanoma who underwent lymphoscintigraphy and in whom SNB was intentionally not performed due to advanced age and/or comorbidities were included. Results Between 2000 and 2009, 160 patients (5.2% of the total) underwent lymphoscintigraphy without SNB because of advanced age and/or comorbidities. Compared with the 2945 patients who had a SNB, the 160 patients were older, had thicker melanomas that were more often located in the head and neck region, and had more SNs in more nodal regions. Of the 160 patients, 150 (94%) were followed with ultrasound examination of their SNs at each follow-up visit; this identified 33% of the nodal recurrences before they became clinically apparent. Compared with SN-positive patients who were treated by completion lymph node dissection, observed patients who developed nodal recurrence had more involved nodes when a delayed lymphadenectomy was performed. Melanoma-specific survival, recurrence-free survival, and distant recurrence-free survival rates were similar, while regional lymph node-free survival was worse. Conclusions Lymphoscintigraphy with focused ultrasound follow-up of SNs is a reasonable management alternative to SNB in patients who are elderly and/or have substantial comorbidities.

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“…In primary localized disease (stage I-II), surgical management is frequently sub-optimal in the elderly patient, presenting inadequate excision margins and subsequent higher-risk of local recurrence, independently from known prognostic factors [ 89 ]. Furthermore, an increasing burden of comorbid conditions, as assessed by the Charlson comorbidity index, has a negative impact on disease-specific and overall survival in the elderly melanoma patient [ 96 ].…”

Section: Clinical Management Of Cutaneous Melanoma In the Elderlymentioning

confidence: 99%

Skin Cancer Epidemics in the Elderly as An Emerging Issue in Geriatric Oncology

et al. 2017

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Skin cancer is a worldwide, emerging clinical need in the elderly white population, with a steady increase in incidence rates, morbidity and related medical costs. Skin cancer is a heterogeneous group of cancers comprising cutaneous melanoma and non-melanoma skin cancers (NMSC), which predominantly affect elderly patients, aged older than 65 years. Melanoma has distinct clinical presentations in the elderly patient and represents a challenging question in terms of clinical management. NMSC includes the basal cell carcinoma and cutaneous squamous cell carcinoma and presents a wide disease spectrum in the elderly population, ranging from low-risk to high-risk tumours, advanced and inoperable disease. Treatment decisions for NMSC are preferentially based on tumour characteristics, patient’s chronological age and physician’s preferences and operational settings. Several treatment options are available for NMSC, from surgery to non-invasive/medical therapies, but patient-based factors, such as geriatric comorbidities and patient’s life expectancy, do not frequently modulate treatment goals. In melanoma, age-related variations in clinical management are significant and may frequently lead to under-treatment, limiting access to advanced surgical and medical treatments. Clinical decision-making in the care of elderly skin cancer patient should ideally implement a geriatric assessment, prioritizing patient-based factors and efficiently differentiating fit from frail cancer patients. Current clinical practice guidelines for NMSC and melanoma only partially address geriatric aspects of cancer care, such as frailty, limited life-expectancy, geriatric comorbidities and treatment compliance. We review the recent evidence on the scope and problem of skin cancer in the elderly population as well as age-related variations in its clinical management, highlighting the potential role of a geriatric approach in optimizing dermato-oncological care.

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Localized melanoma in older patients, the impact of increasing age and comorbid medical conditions

Cited by 23 publications

References 23 publications

Predicting risk for seroma development after axillary or inguinal sentinel lymph node biopsy in melanoma patients

Predicting risk for seroma development after axillary or inguinal sentinel lymph node biopsy in melanoma patients

Focused Ultrasound Surveillance of Lymph Nodes Following Lymphoscintigraphy Without Sentinel Node Biopsy: A Useful and Safe Strategy in Elderly or Frail Melanoma Patients

Skin Cancer Epidemics in the Elderly as An Emerging Issue in Geriatric Oncology

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