Distinctive Features of Melanoma and Its Management in Elderly Patients

Abstract

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.

Clinical and pathological melanoma differences in young and old people

“…3,8 Although numerous risk factors have been associated to the development of MM (including light eyes and low skin phototypes, presence of dysplastic naevi, tendency to freckle and family history of melanoma), the significance of some associations remains unclear, particularly in aged subgroups. [3][4][5] The risk associated with sun exposure and multiple naevi, for example, are controversial.…”

“…3,8 Although numerous risk factors have been associated to the development of MM (including light eyes and low skin phototypes, presence of dysplastic naevi, tendency to freckle and family history of melanoma), the significance of some associations remains unclear, particularly in aged subgroups. [3][4][5] The risk associated with sun exposure and multiple naevi, for example, are controversial. 8,9 Traditional prognostic factors for cutaneous MM include thickness, ulceration, mitoses/mm 2 , clinical stage, anatomic location, sex and age, 10 and although some pathologic features were previously linked to lower disease specific survival rates, 4,5,7,10 some associations remain uncertain in older patients.…”

“…10 In accordance to our findings, several studies suggested that melanoma is more common in older men; 3,4,6-8,10 they have focused on histologic features and/or survival, and few evaluated risk factors for melanoma. 3,5,7,8 MacDonald et al 7 found that melanoma was less likely to arise from a pre-existing naevi in patients older than 70 years. Although multiple naevi is a powerful predictive phenotypic marker for melanoma development, nevi usually involute after the 40 th decade; therefore, they are much less numerous in older patients, 9 thus explaining why we found significantly less elderly with more than 50 naevi.…”

“…1 Despite recent evidence of reduction on the incidence of MM in some younger European populations, global annual incidence and mortality rates have increased, especially in older and fair-skinned populations, particularly in older men. 2,3 Melanoma is often misdiagnosed in older people, including delayed diagnosis, inadequate staging, and suboptimal surgical/adjuvant therapies. [4][5][6] Some melanoma features seem to differ according to age, including prognosis markers and risk factors.…”

“…[4][5][6] Some melanoma features seem to differ according to age, including prognosis markers and risk factors. 3,[5][6][7] This case series aimed to identify clinicopathological differences of MM between older and younger patients.…”