title: Impact of age on the management of primary melanoma patients.
abstract: OBJECTIVE
  Age is an understudied factor when considering treatment options for melanoma. Here, we examine the impact of age on primary melanoma treatment in a prospective cohort of patients.
  
  
  METHODS
  We used logistic regression models to examine the associations between age and initial treatment, using recurrence and melanoma-specific survival as endpoints.
  
  
  RESULTS
  444 primary melanoma patients were categorized into three groups by age at diagnosis: 19-45 years (24.3%), 46-70 (50.2%), and 71-95 (25.5%). In multivariate models, older patients experienced a higher risk of recurrence (hazard ratio 3.34, 95% confidence interval, CI, 1.53-7.25; p < 0.01). No significant differences were observed in positive biopsy margin rates or extent of surgical margins across age groups. Patients in the middle age group were more likely to receive adjuvant therapy than those in the older group (odds ratio 2.78, 95% CI 1.19-6.45; p = 0.02) and showed a trend to longer disease-free survival when receiving adjuvant therapy (p = 0.09).
  
  
  CONCLUSIONS
  Our data support age as an independent negative prognostic factor in melanoma. Our data suggest that age does not affect primary surgical treatment but may affect decisions of whether or not patients receive postoperative treatment(s). Further work is needed to better understand the biological variables affecting treatment decisions and efficacy in older patients.
authors.affiliation: Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, N.Y., USA.
authors.forename: Nathaniel H
authors.initials: NH
authors.lastname: Fleming
authors.forename: Jiaying
authors.initials: J
authors.lastname: Tian
authors.forename: Eleazar
authors.initials: E
authors.lastname: Vega-Saenz de Miera
authors.forename: Heidi
authors.initials: H
authors.lastname: Gold
authors.forename: Farbod
authors.initials: F
authors.lastname: Darvishian
authors.forename: Anna C
authors.initials: AC
authors.lastname: Pavlick
authors.forename: Russell S
authors.initials: RS
authors.lastname: Berman
authors.forename: Richard L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: David
authors.initials: D
authors.lastname: Polsky
authors.forename: Iman
authors.initials: I
authors.lastname: Osman
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000517:prevention & control; D016017:Odds Ratio; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents