Optimizing the management of cutaneous melanoma in the elderly

Background: The incidence of melanoma in patients aged ≥65 years is increasing. Melanoma characteristics appear to be different in the elderly, and outcomes worse. We undertook this study to characterize our experience with melanoma in the elderly and identify factors associated with outcome. Methods: We studied 244 elderly consecutive melanoma patients with clinically localized disease. Mean follow-up was 73 ± 3.7 months. Results: One-hundred thirty-two patients (54%) were male. The most common site was extremity (44%), histology superficial spreading (51%), mean thickness 1.91 mm, 16% ulcerated. T stage included 36% T1, 14% T2, 14% T3, 9% T4 tumors. Undertreatment of the primary tumor occurred in 22%, overtreatment in 6%, and inadequate lymph node staging/treatment in 22%. 23% of patients recurred, 21% died of unrelated causes, and 12% died of melanoma. Sex, tumor thickness, mitotic index, ulceration, and lymph node status were significant factors affecting disease-free survival, while tumor thickness, mitotic index, and lymph node status were significant predictors of overall survival. Conclusion: The features of melanoma in elderly patients were different from younger patients, but prognostic factors were similar. Most patients received appropriate treatment and survived >5 years. Strategies to improve early detection to facilitate optimal treatment of melanoma in the elderly are warranted.