Metastatic Melanoma in the Older Patient

Immunologic Insights and Treatment Outcomes

Upendra P Hegde; Nitya Chakraborty; Bijay Mukherji; Jane M Grant Kels

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2011;11(2):185-193. 

In This Article

Age as a Prognostic Factor of CM

Although early clinical observations demonstrated poor outcomes in CM for older patients, subsequent studies reported mixed results.[9] CM is often diagnosed as being deeper in older patients. This is believed to be a function of delayed diagnosis due to failing sensory inputs of the geriatric patient, as well as their relative lack of participation in preventive screening programs. The risk of ulceration from CM is increased in those with thick tumors. However, data from the Sunbelt Melanoma trial indicated that spread of melanoma to the lymph nodes is decreased in older patients in comparison with younger patients with CM of same thickness.[10] As the long-term prospects were poor in older subjects, it was suggested that melanoma most likely spreads via the hematogenous route in older patients, whereas for the younger patient, the tumor probably spreads to the regional lymph nodes via dermal lymphatics.[11] Other factors described to affect outcome of older patients with CM include loss of spouse and poor socioeconomic status.[12,13] Subsequently, on the basis of an analysis of 17,600 patients in the American Joint Commission on Cancer (AJCC) melanoma staging database, it was confirmed that increasing patient age was an independent prognostic factor with respect to the overall survival rate of patients with CM.[14]

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