title: Localized melanoma in older patients, the impact of increasing age and comorbid medical conditions.
abstract: BACKGROUND
  Elderly patients experience a different spectrum of disease and poorer outcomes than younger patients. This study investigated the impact of age and medical comorbidities on the management and outcome of patients ≥65 years.
  
  
  METHODS
  A retrospective review of all patients ≥65 years (481 patients with 525 primary melanomas) presenting with AJCC clinical stage I-II melanoma to an Australian cancer centre between 2000 and 2008.
  
  
  RESULTS
  The median age was 74 years (65-94) with a male predominance (313 males, 65.0%) and median tumour thickness of 1.90 mm (IQR = 0.40-2.90, T1 = 33%, T2 = 20%, T3 = 24%, T4 = 23%). Inadequate surgical margins of excision (<10 mm) were common in older patients independent of site, thickness and ulceration (OR = 1.04, 95%CI = 1.00-1.07, p = 0.038). Inadequate excision margins were strongly associated with time to local recurrence, independent of age, thickness, ulceration and mitotic rate (HR = 3.00, 95%CI = 1.49-6.03, p = 0.0021), but not time to progression (p = 0.10) or disease specific survival (DSS, p = 0.27). Overall survival (OS) was strongly related to increasing age (HR = 1.04, 95%CI = 1.01-1.07, p = 0.015) and comorbid medical conditions (HR = 1.26, 95%CI = 1.12-1.42, p < 0.001), as assessed by the Charlson comorbidity index (CCI). DSS was significantly related to CCI (HR = 1.20, 95%CI = 1.01-1.42, p = 0.041) and not age (p = 0.46), when adjusting for thickness, ulceration and mitotic rate on multivariate analysis.
  
  
  CONCLUSIONS
  Older patients present with poor prognosis melanomas yet are less likely to receive adequate surgical excision margins resulting in higher rates of local recurrence. In melanoma patients ≥65 years, the increasing number of medical comorbidities explains much of the age related variations in OS and DSS and should be considered when planning treatment.
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Rees
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Liao
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Spillane
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Speakman
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: C
authors.initials: C
authors.lastname: McCormack
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Donahoe
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Pohl
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Webb
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Gyorki
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, 3002, Australia. Electronic address: Michael.Henderson@petermac.org.
authors.forename: M A
authors.initials: MA
authors.lastname: Henderson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D000072662:Margins of Excision; D008545:Melanoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D008940:Mitotic Index; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D012883:Skin Ulcer / Q000453:epidemiology*; D015996:Survival Rate; D047368:Tumor Burden
keywords: Aged; Comorbidity; Disease progression; Melanoma; Mortality