Clinical-histological characteristics and therapeutic management of primary cutaneous melanoma in elderly patients.

Background: Life expectancy is rising in developed countries. The impact of age on melanoma characteristics is unclear, but it seems that melanomas in the elderly have distinct features affecting management and outcomes.

Objectives: To compare clinical and histopathological melanoma characteristics and management in elderly and younger patients.

Methods: A retrospective population-based study analyzed melanomas observed between 2007 and 2022 was made in the southern Seville health area (Spain). Patients were divided into two age groups: <65 and ≥65. Data were collected from clinical histories.

Results: Among 431 primary cutaneous melanomas, 33% were in patients ≥65-years. Elderly patients had more head and neck melanomas (37.8% vs. 14.9%; p < 0.001), larger lesions (1.3 vs. 0.9 cm; p < 0.001), more ulcerated melanomas (17.8% vs. 8.8%; p < 0.012), and higher Breslow thickness (1.03 vs. 0.65 mm; p < 0.01) than younger patients. No differences were found in the number of mitoses or histopathological invasions. Stage 0 and more advanced stages (II/III/IV) were observed more frequently in ≥65-years (29.3% vs. 23% and 27.1% vs. 15.7%, p < 0.001 respectively). Fewer wide excisions (28.4% vs. 5.6%, p < 0.001), sentinel lymph node biopsy (17.6% vs. 2.4%, p < 0.001), and adjuvant therapy (11.9% vs. 2.1%, p < 0.001) were performed in patients ≥65-years.

Study limitations: The study was retrospective, primarily covering the last 10-years, with older data missing. Key risk factors like the number of nevi and family history of melanoma were not collected.

Conclusions: Melanomas in the elderly were diagnosed more frequently at initial and advanced stages despite having worse prognostic characteristics compared melanomas occurring in younger people.