Malignant Melanoma in the Elderly: Different Regional Disease and Poorer Prognosis

Abstract

Purpose: Age is a poor prognostic factor in melanoma patients. Elderly melanoma patients have a different presentation and clinical course than younger patients. We evaluated the impact of age ≥70 years (yrs) on the diagnosis and natural history of melanoma.Methods: Retrospective review of 610 patients with malignant melanoma entered into a prospective sentinel lymph node (SLN) database, treated from June 1997 to June 2010. Disease characteristics and clinical outcomes were compared between patients ≥70 yrs vs. <70 yrs of age.Results: 237 patients (39%) were ≥70 yrs. Elderly patients had a higher proportion of head and neck melanomas (34% vs. 20%, p<0.001), and greater mean tumor thickness (2.4mm vs. 1.8mm, p<0.001). A greater proportion of T3 or T4 melanoma was seen in the elderly (p<0.001) as well as a greater mean number of mitotic figures: 3.6/mm2 vs. 2.7/mm2 (p=0.005). Despite greater mean thickness, the incidence of SLN metastases was less in the ≥70 yrs group with T3/T4 melanomas (18% vs. 33%, p=0.02). The elderly had a higher rate of local and in-transit recurrences, 14.5% vs. 3.4% at 5 yrs (p<0.001). 5 yr disease-specific mortality and overall mortality were worse for those ≥70 yrs: 16% vs. 8% (p=0.004), and 30% vs. 12% (p<0.001), respectively.Conclusions: Elderly (≥70 yrs) melanoma patients present with thicker melanomas and a higher mitotic rate but have fewer SLN metastases. Melanoma in the elderly is more common on the head and neck. Higher incidence of local/in-transit metastases is seen among the elderly. Five-year disease-specific mortality and overall mortality are both worse for these patients.

Responses to immune checkpoint inhibitors in nonagenarians

“…16 In particular, older males had a 157% increase in melanoma mortality between 1969 and 1999. [2][3] In one retrospective analysis, 17 overall mortality and disease-specific mortality at 5 y was statistically inferior in patients 70 y of age. Advancing age is associated with more aggressive biologic behavior, as well as a lower percentage of patients with BRAF mutation, especially V600E BRAF mutation, which is the most sensitive to targeted therapies.…”

“…In several studies, increasing age was significantly associated with poor prognostic markers of Breslow thickness, ulceration, and male gender. [17][18][19][20][21] Moreover, with the anticipated growth in the elderly population, the number of older melanoma patients seeking treatment is predicted to lead to increased healthcare costs and utilization of resources, 22 underscoring the importance of optimal management of melanoma in the elderly.…”

Clinical and pathological melanoma differences in young and old people

“…[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.…”

“…[4][5][6] Some melanoma features seem to differ according to age, including prognosis markers and risk factors. 3,[5][6][7] This case series aimed to identify clinicopathological differences of MM between older and younger patients.…”

The role of osteopontin expression in melanoma progression

“…Malignant melanoma is the most aggressive type of skin cancer, with rapidly increasing incidence worldwide [1][2][3]. Despite previous intensive research to advance our understanding of melanoma progression, therapeutic options remain limited, and melanoma is mainly cured surgically [4,5].…”