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.
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.
Authors: Charles M Balch; John F Thompson; Jeffrey E Gershenwald; Seng-Jaw Soong; Shouluan Ding; Kelly M McMasters; Daniel G Coit; Alexander M M Eggermont; Phyllis A Gimotty; Timothy M Johnson; John M Kirkwood; Stanley P Leong; Merrick I Ross; David R Byrd; Alistair J Cochran; Martin C Mihm; Donald L Morton; Michael B Atkins; Keith T Flaherty; Vernon K Sondak Journal: Ann Surg Oncol Date: 2014-02-15 Impact factor: 5.344
Authors: Alessio Cortellini; Melissa Bersanelli; Sebastiano Buti; Katia Cannita; Daniele Santini; Fabiana Perrone; Raffaele Giusti; Marcello Tiseo; Maria Michiara; Pietro Di Marino; Nicola Tinari; Michele De Tursi; Federica Zoratto; Enzo Veltri; Riccardo Marconcini; Francesco Malorgio; Marco Russano; Cecilia Anesi; Tea Zeppola; Marco Filetti; Paolo Marchetti; Andrea Botticelli; Gian Carlo Antonini Cappellini; Federica De Galitiis; Maria Giuseppa Vitale; Francesca Rastelli; Federica Pergolesi; Rossana Berardi; Silvia Rinaldi; Marianna Tudini; Rosa Rita Silva; Annagrazia Pireddu; Francesco Atzori; Rita Chiari; Biagio Ricciuti; Andrea De Giglio; Daniela Iacono; Alain Gelibter; Mario Alberto Occhipinti; Alessandro Parisi; Giampiero Porzio; Maria Concetta Fargnoli; Paolo Antonio Ascierto; Corrado Ficorella; Clara Natoli Journal: J Immunother Cancer Date: 2019-02-27 Impact factor: 13.751