Melanoma in the very elderly, management in patients 85 years of age and over

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

doi:10.1016/j.jgo.2018.01.001

Cited by 15 publications

(7 citation statements)

References 23 publications

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“…The results of a SEERbased study demonstrated that MM was one of the top 10 cancers with the highest CVD mortality [25]. In a retrospective analysis of 127 older MM patients, 34.7% died of non-MM diseases, including CVD [26]. Similarly, a study of 213,716 MM patients showed that CVDspecific death increased with age at MM diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Risk of Cardiovascular Disease Death in Older Malignant Melanoma Patients: A Population-Based Study

Miao

Wang

et al. 2022

Cancers

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Noncancer deaths account for a large proportion of deaths in patients with malignant melanoma (MM), but the risk of cardiovascular disease (CVD) death in older MM patients remains unclear. This study aimed to estimate the risk of CVD death in older MM patients. Data on older MM patients were obtained in the Surveillance, Epidemiology, and End Results database. Risk of CVD death was calculated by standardized mortality rates (SMRs), cumulative mortality and proportion of different causes of death. MM patients had a higher risk of CVD death than general populations (SMR = 1.98; 95% CI 1.93–2.03, p < 0.001). CVD death was more common in MM patients who were diagnosed at age 85 or older, had a localized stage, were white, had surgical treatment, had a primary head/neck/upper limb site and had a low-grade and superficial spreading/lentigo malignant pathologic type. Cumulative CVD mortality was more common than primary cancer in all older age groups, male or female, and patients with localized-stage disease. Other than primary cancer, CVD was the main cause of death in older patients diagnosed with MM. Our findings highlight CVD death is an important competing event of deaths in older MM patients, and more attention should be paid to reducing CVD death to improve survival.

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Section: Discussionmentioning

confidence: 99%

Risk of Cardiovascular Disease Death in Older Malignant Melanoma Patients: A Population-Based Study

Miao

Wang

et al. 2022

Cancers

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“…On the contrary, patients younger than 65 years had a 0.9% per year decrease in The reason for worse outcomes in older patients with cutaneous melanoma remains multifactorial. 18 Rees et al 19 reviewed 127 patients with cutaneous melanoma in their 85th year and older, finding high frequency of poor prognostic features at presentation, including tumor ulceration in 49.5%, mitotically active tumor in 68.3%, median tumor thickness of 3.7 mm, and excision margin ,10 mm in 33.7%, which was associated with higher risk of local tumor recurrence (HR 6.87, P = 0.0045). Similarly, Huayllani et al 20 years was directly associated with higher frequency of male sex, head and neck tumor location, all-site tumor relapse, metastasis, and melanoma-related death.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for worse outcomes in older patients with cutaneous melanoma remains multifactorial. 18 Rees et al 19 reviewed 127 patients with cutaneous melanoma in their 85th year and older, finding high frequency of poor prognostic features at presentation, including tumor ulceration in 49.5%, mitotically active tumor in 68.3%, median tumor thickness of 3.7 mm, and excision margin <10 mm in 33.7%, which was associated with higher risk of local tumor recurrence (HR 6.87, P = 0.0045). Similarly, Huayllani et al 20 reviewed 26,440 patients with cutaneous melanoma from the National Cancer Database and found that along with head and neck location, older patient age was associated with residual tumor in margins for Breslow depth groups ≤1 mm and >2 mm.…”

Section: Discussionmentioning

confidence: 99%

Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center

Dalvin

Yaghy

Vaidya

et al. 2020

Cornea

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To investigate the clinical features and outcomes for conjunctival melanoma based on patient age. Methods: A retrospective review of patients with conjunctival melanoma managed at a single tertiary referral center from April 18, 1974, to September 9, 2019. Clinical features and outcomes were compared by patient age category at presentation (young #45 years, middle-aged 46-69 years, and older $70 years), with Kaplan-Meier and Cox proportional hazard analysis [hazard ratio (95% confidence interval)].Results: There were 629 patients categorized as young in 130 (21%), middle-aged in 278 (44%), and older in 221 (35%). A comparison by age category (young vs. middle-aged vs. older) revealed that older patients had melanoma with greater number of affected quadrants (1.7 vs. 1.8 vs. 2.0, P = 0.001) and clock hours (3.9 vs. 4.2 vs. 5.2, P = 0.001). All patients were treated with surgical excision, with no difference in requirement for additional medical or radiation therapy. By 10-year Kaplan-Meier outcomes, older patients had more frequent visual acuity loss $3 lines (11% vs. 28% vs. 64%, P , 0.001) and local tumor recurrence (38% vs. 46% vs. 70%, P , 0.001). Hazard ratio for the oldest age group (age $70) revealed a 7.76-fold (3.33-18.09) increased risk for visual acuity loss (P , 0.001), and a 2. 08-fold (1.32-3.28) increased risk of local tumor recurrence (P = 0.002). There was no difference by age in risk for enucleation, exenteration, locoregional lymph node involvement, distant systemic metastasis, or death. Conclusions:Older patients with conjunctival melanoma present with more extensive disease and have increased risk for visual acuity loss and local tumor recurrence.

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“…Such a distinctive clinicopathological profile prompts dedicated primary and secondary prevention strategies, personalized diagnostic and therapeutic procedures, and age-tailored post-treatment follow-up schedules [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Cutaneous melanoma in older patients

Buja,

Rugge,

Trevisiol

et al. 2024

BMC Geriatr

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Background In industrialized countries, the aging population is steadily rising. The incidence of cutaneous malignant melanoma (CMM) is highest in old people. This study focuses on the clinicopathological profile of CMM and indicators of diagnostic-therapeutic performance in older patients. Methods This retrospective population-based cohort study included 1,368 incident CMM, as recorded in 2017 by the Regional Veneto Cancer Registry (Northeast Italy). Older subjects were defined as ≥ 80, old as 65–79, and adults as < 65 years of age. The strength of association between pairs of variables was tested by Cramer’s-V. Using age groups as the dependent variable, ordered logistic regression was fitted using the clinicopathological CMM profiles as covariates. In each of the three age-groups, the indicators of clinical performance were computed using the Clopper-Pearson exact method. Results Compared to patients aged younger than 80 years (1,187), CMM in older patients (181; 13.2%) featured different CMM topography, a higher prevalence of ulcers (43.3% versus 12.7%; p < 0.001), a higher Breslow index (p < 0.001), a lower prevalence of tumor-infiltrating lymphocytes (64.4% versus 76.5%, p < 0.01), and a more advanced pTNM stage at clinical presentation (p < 0.001). Elderly patients with a positive sentinel-lymph node less frequently underwent sentinel- lymph node biopsy and lymphadenectomy (60.0% versus 94.2%, and 44.4% versus 85.5%, respectively; p < 0.001). Conclusions In older CMM patients, the clinicopathological presentation of CMM shows a distinctive profile. The present results provide critical information to optimize secondary prevention strategies and refine diagnostic-therapeutic procedures tailored to older patients.

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Melanoma in the very elderly, management in patients 85 years of age and over

Cited by 15 publications

References 23 publications

Risk of Cardiovascular Disease Death in Older Malignant Melanoma Patients: A Population-Based Study

Risk of Cardiovascular Disease Death in Older Malignant Melanoma Patients: A Population-Based Study

Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center

Cutaneous melanoma in older patients

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