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Melanoma experience differed for elderly, younger patients
Age-related variations were observed throughout treatment for patients with melanoma and might contribute to poorer prognoses for the elderly, according to recent study results.
In a retrospective population-based study in France, researchers evaluated 1,621 patients (mean age, 48 years; 52% women) with stage 1 or II melanoma diagnosed as primary cutaneous melanoma in 2004 or 2008. Data was obtained from physician questionnaires and a survey of cancer registries and pathology laboratories.
Patients were categorized by age with an older group aged at least 70 years (n=487 patients; mean age, 78 years; 49.6% women) and a younger group aged younger than 70 years (n=1,134; mean age, 50 years; 53% women).
The older patients experienced more melanomas of the head and neck (29.4% vs. 8.7%; P<.001) than younger patients, along with greater frequency of nodular, lentigo maligna or acral lentiginous melanomas (37.9% vs. 15.4%; P<.001). Older patients’ tumors were thick and more frequently ulcerated (stage T3 or T4) in 36.7% of cases compared with 20.1% of younger patients.
Older patients were diagnosed with melanoma in general practice settings (18.7%) more often than at regular skin cancer screenings (3.5%). After diagnoses, older patients experienced longer time to definitive excision, with 16.8% having insufficient excision margins compared with 5% in younger patients (P<.001). For patients with melanoma thicker than 1 mm, a sentinel lymph node biopsy was performed in 23.3% of older patients vs. 41.1% of younger patients (P<.001). Adjuvant therapy was recommended more commonly to younger patients than to older patients (58.8% vs. 18.9%; P<.001).
“Age-related variations are observed at every step of melanoma management,” the researchers concluded. “The most important concerns are access of elderly people to settings for early diagnosis and excision with appropriate margins.
“It may therefore be hypothesized that age-related variations in the management of melanoma in the present study might contribute to a poorer overall prognosis in the elderly.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Melanoma incidence has been steadily increasing during the past 25 years, and mortality rates are higher in older patients. Delay in diagnosis resulting in a higher Breslow thickness, head and neck location, and increased frequency of nodular melanoma subtype are thought to contribute to poorer prognosis in older patients.
Ciocan and colleagues found that patients aged 70 years and older had thicker melanomas of more aggressive subtypes, were less likely to be screened by a dermatologist, and more often had melanoma diagnosis made in general practice settings compared with younger patients. They had a higher rate of insufficient excision margin and longer delay to excision, and sentinel lymph node biopsy (SLNB) was less frequently performed. Despite more advanced tumors, medical imaging was performed less often, and adjuvant therapy (interferon alfa) was less frequently proposed and more frequently stopped in older patients. These finding suggest a disparity of care between older and younger patients, although effects on survival of surgical margins, performance of SLNB and staging are unknown. Earlier detection, including education regarding nodular melanoma, is needed to improve prognosis in elderly patients. Further study is needed to confirm if the variations in management of melanoma contribute to overall poorer prognosis in the elderly.