J Cancer 2011; 2:538-543. doi:10.7150/jca.2.538

Research Paper

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

James B. Macdonald1, Amylou C. Dueck2, Richard J. Gray3, Nabil Wasif3, David L. Swanson1, Aleksandar Sekulic1, Barbara A. Pockaj3 ✉

1. Department of Dermatology, Mayo Clinic Arizona, 5777 E Mayo Boulevard, Phoenix, AZ 85054, USA.
2. Department of Biostatistics, Mayo Clinic Arizona, 5777 E Mayo Boulevard, Phoenix, AZ 85054, USA.
3. Department of Surgery, Mayo Clinic Arizona, 5777 E Mayo Boulevard, Phoenix, AZ 85054, USA.

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.

Keywords: Elderly patients, metastases, melanoma

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How to cite this article:
Macdonald JB, Dueck AC, Gray RJ, Wasif N, Swanson DL, Sekulic A, Pockaj BA. Malignant Melanoma in the Elderly: Different Regional Disease and Poorer Prognosis. J Cancer 2011; 2:538-543. doi:10.7150/jca.2.538. Available from http://www.jcancer.org/v02p0538.htm