Management of Melanoma in Elderly Patients over 80 Years

Authors

  • Héloïse Jourdain Dermatology Department, Dupuytren 2 University Hospital, Limoges, France
  • Justine Lavaud Dermatology Department, Dupuytren 2 University Hospital, Limoges, France
  • Clémentine Descours Dermatology Department, Dupuytren 2 University Hospital, Limoges, France
  • Emilie Auditeau Department of Epidemiology, Dupuytren University Hospital, Limoges, France
  • Philippe Bernard Dermatology Department, Dupuytren 2 University Hospital, Limoges, France

DOI:

https://doi.org/10.2340/actadv.v104.41029

Keywords:

melanoma, elderly, treatment, initial staging

Abstract

Melanoma is a malignant tumour with a poorer prognosis in stage III and IV patients. Development of effective therapies for the treatment of advanced melanoma has led to an improvement in survival. Furthermore,
the French population is ageing, and treatment of melanoma in this population has several specific limitations. This descriptive, retrospective, single-centre study collected data on the diagnostic and therapeutic
management of patients with melanoma of Breslow ≥ 1 mm or of unknown primary and metastatic spread, at Limoges University Hospital, between 2018 and 2022, and compared the results obtained between 2 groups: under 80 and over 80 years of age; 344 patients were included. The extension work-up was more frequently complete and the sentinel lymph node technique more frequently performed in patients under 80. Wide excision was more frequently in accordance with guidelines in patients over 80. Adjuvant or first-line metastatic treat-ment was more frequently instituted in patients under 80, but no difference was found as regards the second and third lines, the frequency of adverse events, and the reason for stopping treatment. Our study supports similar management of elderly and young subjects, given the safety profile and efficacy of treatments.

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References

Epidémiologie des cancers cutanés - Détection précoce des cancers de la peau [Internet] [cited 2023 Jan 14]. Available from: https://www.e-cancer.fr/Professionnels-de-sante/Depistage-et-detection-precoce/Detection-precoce-des-cancers-de-la-peau/Epidemiologie?fbclid=IwAR0Y4fXo3Gkpp_waY2hrG7CFLXv-qflYa2t-g_V58MWd0lt5UjWueBQbBxo

Hollestein LM, Van Den Akker SAW, Nijsten T, Karim-Kos HE, Coebergh JW, De Vries E. Trends of cutaneous melanoma in The Netherlands: increasing incidence rates among all Breslow thickness categories and rising mortality rates since 1989. Ann Oncol 2012; 23: 524-530.

https://doi.org/10.1093/annonc/mdr128 DOI: https://doi.org/10.1093/annonc/mdr128

Accueil - Insee - Institut national de la statistique et des études économiques [Internet]. [cited 2024 Jun 1]. Available from: https://www.insee.fr/fr/accueil

Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, et al. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022. Eur J Cancer 2022; 170: 256-284.

https://doi.org/10.1016/j.ejca.2022.04.018 DOI: https://doi.org/10.1016/j.ejca.2022.04.018

Rees MJ, Liao H, Spillane J, Speakman D, McCormack C, Donahoe S, et al. Melanoma in the very elderly, management in patients 85 years of age and over. J Geriatr Oncol 2018; 9: 488-493.

https://doi.org/10.1016/j.jgo.2018.01.001 DOI: https://doi.org/10.1016/j.jgo.2018.01.001

Purim KSM, Bonetti JPC, Silva JYF, Marques LB, Pinto MCS, Ribeiro LC. Characteristics of melanoma in the elderly [in Portuguese]. Rev Colégio Bras Cir 2020; 47: e20202441.

https://doi.org/10.1590/0100-6991e-20202441 DOI: https://doi.org/10.1590/0100-6991e-20202441

Ciocan D, Barbe C, Aubin F, Granel-Brocard F, Lipsker D, Velten M, et al. Distinctive features of melanoma and its management in elderly patients: a population-based study in France. JAMA Dermatol 2013; 149: 1150.

https://doi.org/10.1001/jamadermatol.2013.706 DOI: https://doi.org/10.1001/jamadermatol.2013.706

Macdonald JB, Dueck AC, Gray RJ, Wasif N, Swanson DL, Sekulic A, et al. Malignant melanoma in the elderly: different regional disease and poorer prognosis. J Cancer 2011; 2: 538-543.

https://doi.org/10.7150/jca.2.538 DOI: https://doi.org/10.7150/jca.2.538

Van Der Kooij MK, Wetzels MJAL, Aarts MJB, Van Den Berkmortel FWPJ, Blank CU, Boers-Sonderen MJ, et al. Age does matter in adolescents and young adults versus older adults with advanced melanoma: a national cohort study comparing tumor characteristics, treatment pattern, toxicity and response. Cancers 2020; 12: 2072.

https://doi.org/10.3390/cancers12082072 DOI: https://doi.org/10.3390/cancers12082072

Menzies AM, Haydu LE, Visintin L, Carlino MS, Howle JR, Thompson JF, et al. Distinguishing Clinicopathologic Features of Patients with V600E and V600K BRAF-mutant metastatic melanoma. Clin Cancer Res 2012; 18: 3242-3249.

https://doi.org/10.1158/1078-0432.CCR-12-0052 DOI: https://doi.org/10.1158/1078-0432.CCR-12-0052

Liu W, Dowling JP, Murray WK, McArthur GA, Thompson JF, Wolfe R, et al. Rate of growth in melanomas: characteristics and associations of rapidly growing melanomas. Arch Dermatol 2006; 142: 1551-1558.

https://doi.org/10.1001/archderm.142.12.1551 DOI: https://doi.org/10.1001/archderm.142.12.1551

Rees MJ, Liao H, Spillane J, Speakman D, McCormack C, Donahoe S, et al. Localized melanoma in older patients, the impact of increasing age and comorbid medical conditions. Eur J Surg Oncol EJSO 2016; 42: 1359-1366.

https://doi.org/10.1016/j.ejso.2016.01.010 DOI: https://doi.org/10.1016/j.ejso.2016.01.010

Chang CK, Jacobs IA, Vizgirda VM, Salti GI. Melanoma in the elderly patient. Arch Surg 2003; 138: 1135-1138.

https://doi.org/10.1001/archsurg.138.10.1135 DOI: https://doi.org/10.1001/archsurg.138.10.1135

Bateni SB, Johns AJ, Gingrich AA, Gholami S, Bold RJ, Canter RJ, et al. Elderly age is associated with more conservative treatment of invasive melanoma. Anticancer Res 2020; 40: 2895-2903.

https://doi.org/10.21873/anticanres.14266 DOI: https://doi.org/10.21873/anticanres.14266

Sassen S, Shaw HM, Colman MH, Scolyer RA, Thompson JF. The complex relationships between sentinel node positivity, patient age, and primary tumor desmoplasia: analysis of 2303 melanoma patients treated at a single center. Ann Surg Oncol 2008; 15: 630-637.

https://doi.org/10.1245/s10434-007-9684-1 DOI: https://doi.org/10.1245/s10434-007-9684-1

Perier-Muzet M, Gatt E, Péron J, Falandry C, Amini-Adlé M, Thomas L, et al. Association of immunotherapy with overall survival in elderly patients with melanoma. JAMA Dermatol 2018; 154: 82-87.

https://doi.org/10.1001/jamadermatol.2017.4584 DOI: https://doi.org/10.1001/jamadermatol.2017.4584

Eggermont AMM, Blank CU, Mandala M, Long GV, Atkinson V, Dalle S, et al. Adjuvant pembrolizumab versus placebo in resected stage iii melanoma. N Engl J Med 2018; 378: 1789-1801.

https://doi.org/10.1056/NEJMoa1802357 DOI: https://doi.org/10.1056/NEJMoa1802357

Larkin J, Ascierto PA, Dréno B, Atkinson V, Liszkay G, Maio M, et al. Combined vemurafenib and cobimetinib in BRAF-mutated melanoma. N Engl J Med 2014; 371: 1867-1876.

https://doi.org/10.1056/NEJMoa1408868 DOI: https://doi.org/10.1056/NEJMoa1408868

Robert C, Karaszewska B, Schachter J, Rutkowski P, Mackiewicz A, Stroiakovski D, et al. Improved overall survival in melanoma with combined dabrafenib and trametinib. N Engl J Med 2015; 372: 30-39.

https://doi.org/10.1056/NEJMoa1412690 DOI: https://doi.org/10.1056/NEJMoa1412690

Reichert C, Baldini C, Mezghani S, Maubec E, Longvert C, Mortier L, et al. Combined nivolumab and ipilimumab in octogenarian and nonagenarian melanoma patients. Cancers 2023; 15: 4330.

https://doi.org/10.3390/cancers15174330 DOI: https://doi.org/10.3390/cancers15174330

Bobircă F, Tebeică T, Pumnea A, Dumitrescu D, Alexandru C, Banciu L, et al. The characteristics of sentinel lymph node biopsy in cutaneous melanoma and the particularities for elderly patients: experience of a single clinic. Diagnostics 2023; 13: 926.

https://doi.org/10.3390/diagnostics13050926 DOI: https://doi.org/10.3390/diagnostics13050926

Solari N, Bertoglio S, Boscaneanu A, Minuto M, Reina S, Palombo D, et al. Sentinel lymph node biopsy in patients with malignant melanoma: analysis of post-operative complications. ANZ J Surg 2019; 89: 1041-1044.

https://doi.org/10.1111/ans.15358 DOI: https://doi.org/10.1111/ans.15358

Fox B, de Toro Carmena M, Álvarez Álvarez R, Calles Blanco A, López López C, Pérez Ramírez S, et al. Efficacy and safety of immune checkpoint inhibitor immunotherapy in elderly cancer patients. Clin Transl Oncol 2020; 22: 555-562.

https://doi.org/10.1007/s12094-019-02161-4 DOI: https://doi.org/10.1007/s12094-019-02161-4

Paderi A, Fancelli S, Caliman E, Pillozzi S, Gambale E, Mela MM, et al. Safety of immune checkpoint inhibitors in elderly patients: an observational study. Curr Oncol 2021; 28: 3259-3267.

https://doi.org/10.3390/curroncol28050283 DOI: https://doi.org/10.3390/curroncol28050283

Darwin A, Skinner A, Reed DR, Tanvetyanon T. Immune-related toxicity among adolescent and young adult with melanoma as compared with the elderly. J Adolesc Young Adult Oncol 2022; 11: 550-555.

https://doi.org/10.1089/jayao.2021.0180 DOI: https://doi.org/10.1089/jayao.2021.0180

Becquart O, Oriano B, Dalle S, Mortier L, Leccia MT, Dutriaux C, et al. Tolerance and effectiveness of targeted therapies in aged patients with metastatic melanoma. Cancers 2021; 13: 3042.

https://doi.org/10.3390/cancers13123042 DOI: https://doi.org/10.3390/cancers13123042

Betof AS, Nipp RD, Giobbie-Hurder A, Johnpulle RAN, Rubin K, Rubinstein SM, et al. Impact of age on outcomes with immunotherapy for patients with melanoma. Oncologist 2017; 22: 963-971.

https://doi.org/10.1634/theoncologist.2016-0450 DOI: https://doi.org/10.1634/theoncologist.2016-0450

Stoff R, Grynberg S, Asher N, Laks S, Steinberg Y, Schachter J, et al. Efficacy and toxicity of ipilimumab-nivolumab combination therapy in elderly metastatic melanoma patients. Front Oncol 2022; 12: 1020058.

https://doi.org/10.3389/fonc.2022.1020058 DOI: https://doi.org/10.3389/fonc.2022.1020058

Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001; 19: 3622-3634.

https://doi.org/10.1200/JCO.2001.19.16.3622 DOI: https://doi.org/10.1200/JCO.2001.19.16.3622

Chao C, Martin RCG, Ross MI, Reintgen DS, Edwards MJ, Noyes RD, et al. Correlation between prognostic factors and increasing age in melanoma. Ann Surg Oncol 2004; 11: 259-264.

https://doi.org/10.1245/ASO.2004.04.015 DOI: https://doi.org/10.1245/ASO.2004.04.015

Huayllani MT, Sisti A, Restrepo DJ, Boczar D, Cochuyt JJ, Spaulding AC, et al. Desmoplastic melanoma: clinical characteristics and survival in the US population. Cureus 2019; 11: e4931.

https://doi.org/10.7759/cureus.4931 DOI: https://doi.org/10.7759/cureus.4931

Geller AC, Sober AJ, Zhang Z, Brooks DR, Miller DR, Halpern A, et al. Strategies for improving melanoma education and screening for men age >or= 50 years: findings from the American Academy of Dermatological National Skin Cancer Sreening Program. Cancer 2002; 95: 1554-1561.

https://doi.org/10.1002/cncr.10855 DOI: https://doi.org/10.1002/cncr.10855

Testori A, Stanganelli I, Della Grazia L, Mahadavan L. Diagnosis of melanoma in the elderly and surgical implications. Surg Oncol 2004; 13: 211-221.

https://doi.org/10.1016/j.suronc.2004.09.002 DOI: https://doi.org/10.1016/j.suronc.2004.09.002

Oliveria SA, Christos PJ, Halpern AC, Fine JA, Barnhill RL, Berwick M. Evaluation of factors associated with skin self-examination. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 1999; 8: 971-978.

Published

2024-11-13

How to Cite

Jourdain, H., Lavaud, J., Descours, C., Auditeau, E., & Bernard, P. (2024). Management of Melanoma in Elderly Patients over 80 Years. Acta Dermato-Venereologica, 104, adv41029. https://doi.org/10.2340/actadv.v104.41029