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Age-Related Variations Observed in Treatment of Melanoma

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Key Points

  • Compared to younger patients, patients aged 70 years or older had more frequent melanomas involving the head and neck, had thicker melanomas, and were more likely to have ulcerated lesions.
  • Older patients were more likely to be diagnosed in a general practice setting than in direct consultation with a dermatologist.
  • Time to definitive excision was longer in older patients, and 16.8% had insufficient margins compared with 5% of the younger population.

Age-related variations in the treatment of melanoma were observed in a study of melanoma and its management in the elderly compared to younger patients, according to a study by Dragos Ciocan, MD, of the Unité d’Aide Méthodologique, Hôpital Robert Debré, France, and colleagues. The findings were published online today in JAMA Dermatology.

The retrospective, population-based study included 1,621 patients diagnosed with stage I or stage II melanoma in 2004 and 2008. Questionnaires to physicians, a survey of cancer registries, and pathology laboratories were used to obtain data for the study, which was conducted in five regions in northeastern France.

Study Outcomes

Compared to younger patients, patients aged 70 years or older had more frequent melanomas involving the head and neck (29.4% vs 8.7%, P < .001), and a lower proportion of melanomas located on the trunk and lower limbs (28.6% vs 41.5% and 24.5% vs 32.8%, respectively; P < .001 for both). Older patients also had thicker melanomas (mean Breslow thickness, 2.34 vs 1.35 mm, P < .001) and were more likely to have ulcerated lesions (20.9% vs 12.4%, P < .001), which resulted in more advanced stage tumors.

Diagnosis of melanoma in older patients 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 also was longer in older patients, 16.8% of whom had insufficient margins, compared with 5% of the younger population. Adjuvant therapy also was started less frequently in older patients and was prematurely stopped in a higher proportion of that population, according to the study results.

“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,” the authors concluded.

The authors reported no potential conflicts of interest. The study was supported by grants form the Ligue Contre le Cancer, the Société Française de Dermatologie, and the Fondation de France.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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