Distinctive Features of Melanoma and Its Management in Elderly Patients: A Population-Based Study in France

Selected by Pietro Cazzola

MelanomaABSTRACT

Importance: Life expectancy is increasing in most developed countries, and elderly people have the highest incidence of melanoma.

Objective: To identify characteristics of melanoma and its management in the elderly compared with younger patients.

Design, Setting, and Participants: Retrospective population-based study of incident cases of primary melanoma in 1621 patients with stage I or II melanoma in 2004 and 2008. Questionnaires administered to physicians and a survey of cancer registries and pathology laboratories were used to obtain data. The study was conducted in 5 regions in northeastern France.

Main Outcomes and Measures: Characteristics of patients and tumors, circumstances of diagnosis, and further management in older patients (≥70 years, 487 patients [30.0%]) compared with younger ones (<70 years, 1134 [70.0%]).

Results: Older patients had more frequent melanomas of the head and neck (29.4% vs 8.7%; P < .001) and of the nodular, lentigo maligna, or acral lentiginous histologic subtypes. They had thicker and more frequently ulcerated tumors, categorized as T3 or T4 in 36.7% of cases vs 20.1% in younger patients. Diagnosis of melanoma occurred more frequently in a general practice setting and less frequently in direct consultation with a dermatologist or regular screening for skin cancer. Time to definitive excision was longer in older patients, and 16.8% of them compared with 5.0% of the younger population had insufficient excision margins (P < .001). A sentinel lymph node biopsy was performed in 23.3% of the older patients with melanoma thicker than 1 mm vs 41.4% in the younger patients (P < .001). Adjuvant therapy was less frequently started in older patients and was prematurely stopped in a higher proportion of that population.

Conclusions and Relevance: Age-related variations are observed at every step of melanoma management. The most important concerns are access of elderly people to settings for early diagnosis and excision with appropriate margins.

D Ciocan, C Barbe, F Aubin, F Granel-Brocard, D Lipsker, M Velten, S Dalac, F Truchetet, C Michel, A Mitschler, G Arnoult, A Buemi, S Dalle, P Bernard, AS Woronoff, F Grange
Distinctive Features of Melanoma and Its Management in Elderly Patients: A Population-Based Study in France
JAMA Dermatol 2013 Aug 14;[EPub Ahead of Print],