title: Age as a prognostic factor in patients with localized melanoma and regional metastases.
abstract: BACKGROUND
  We postulated that the worse prognosis of melanoma with advancing age reflected more aggressive tumor biology and that in younger patients the prognosis would be more favorable.
  
  
  METHODS
  The expanded AJCC melanoma staging database contained 11,088 patients with complete data for analysis, including mitotic rate.
  
  
  RESULTS
  With increasing age by decade, primary melanomas were thicker, exhibited higher mitotic rates, and were more likely to be ulcerated. In a multivariate analysis of patients with localized melanoma, thickness and ulceration were highly significant predictors of outcome at all decades of life (except for patients younger than 20 years). Mitotic rate was significantly predictive in all age groups except patients <20 and >80 years. For patients with stage III melanoma, there were four independent variables associated with patient survival: number of nodal metastases, patient age, ulceration, and mitotic rate. Patients younger than 20 years of age had primary tumors with slightly more aggressive features, a higher incidence of sentinel lymph node metastasis, but, paradoxically, more favorable survival than all other age groups. In contrast, patients >70 years old had primary melanomas with the most aggressive prognostic features, were more likely to be head and neck primaries, and were associated with a higher mortality rate than the other age groups. Surprisingly, however, these patients had a lower rate of sentinel lymph node metastasis per T stage. Among patients between the two age extremes, clinicopathologic features and survival tended to be more homogeneous.
  
  
  CONCLUSIONS
  Melanomas in patients at the extremes of age have a distinct natural history.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA, charles.balch@utsouthwestern.edu.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Balch
authors.forename: Seng-jaw
authors.initials: SJ
authors.lastname: Soong
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
authors.forename: Michael B
authors.initials: MB
authors.lastname: Atkins
authors.forename: Shouluan
authors.initials: S
authors.lastname: Ding
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Cochran
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Keith T
authors.initials: KT
authors.lastname: Flaherty
authors.forename: Phyllis A
authors.initials: PA
authors.lastname: Gimotty
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Johnson
authors.forename: John M
authors.initials: JM
authors.lastname: Kirkwood
authors.forename: Stanley P
authors.initials: SP
authors.lastname: Leong
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Martin C
authors.initials: MC
authors.lastname: Mihm
authors.forename: Donald L
authors.initials: DL
authors.lastname: Morton
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D008938:Mitosis; D009367:Neoplasm Staging; D011379:Prognosis; D012883:Skin Ulcer / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate; D055815:Young Adult