Cutaneous melanoma with nodal metastases in elderly people

• Published in: International Journal of Dermatology 2010-08, Vol.49 (8), p.907-913
• Main Authors: Rutkowski, Piotr, Nowecki, Zbigniew I., Zdzienicki, Marcin, Michej, Wanda, Symonides, Malgorzata, Rosinska, Magdalena, Dziewirski, Wirginiusz, Bylina, Elzbieta, Ruka, Wlodzimierz
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Aging; Biological and medical sciences; Dermatology; Female; Follow-Up Studies; Humans; Incidence; Lymph Node Excision; Lymphatic Metastasis; Male; Medical sciences; Melanoma - mortality; Melanoma - secondary; Middle Aged; Multivariate Analysis; Neoplasm Staging - mortality; Prognosis; Sex Distribution; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Tumors of the skin and soft tissue. Premalignant lesions; Young Adult
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1111/j.1365-4632.2009.04386.x

Background  The impact of age on melanoma patient outcomes is uncertain. Objective  The aim of the study was to analyze the characteristics and treatment outcomes in cutaneous melanoma patients ≥ 65 years of age with lymph node metastases. Methods  We analyzed data from 849 consecutive patients with stage III cutaneous melanoma who were treated between 1994 and 2007 at one institution. Of these, 225 (26.5%) were ≥ 65 years of age. The characteristics and disease‐specific survival (DSS) from lymph node dissection (LND) date of patients ≥ 65 years of age were compared with those of younger patients. Median follow‐up time was 49 months (range: 6–140 months). Results  In the ≥ 65 years group (51.6% men), the median Breslow thickness was 5.0 mm and 70% was ulcerated. The 5‐year DSS rate was significantly lower in older patients (34%). Multivariate analysis identified older age as an independent prognostic factor for DSS in the overall group. Independent negative prognostic factors of DSS in the group of older stage III patients were identified as features of nodal metastases (extracapsular invasion, HR = 1.74, P = 0.009; and ≥ 4 involved lymph nodes, HR = 1.5; P = 0.008) and male sex (HR = 1.5; P = 0.039). Conclusions  This analysis showed that melanoma patients ≥ 65 years of age are characterized by a higher primary tumor stage and worse prognosis in the presence of regional node metastases than younger patients. Additionally, the results indicate that the same radical surgical therapy is necessary for patients ≥ 65 years old as in younger patients.