Introduction: Australia has the highest incidence of melanoma worldwide. Current evidence suggests elderly patients experience a different spectrum of disease and a significantly worse prognosis than younger patients.
Aim: This study describes the demographics, presentation, and care of elderly Australians with melanoma.
Methods: A retrospective review of all patients aged ≥65 years (n=595) who presented with clinical AJCC stage 0, I or II melanoma, to Peter MacCallum Cancer Centre between the years 2000-2008. These patients were then compared with a randomly selected cohort of melanoma patients aged <65 years (n= 331).
Results: 188 in-situ melanomas in 149 patients were identified. The incidence of in-situ melanoma increased significantly with age (p=0.015), and elderly patients experienced a significantly higher proportion of lentigo maligna (p<0.0001) and head and neck disease (p<0.001). 832 cases of stage I -II disease in 777 patients were identified. The proportion of patients with nodular melanoma increased significantly with age (p=0.0078). Melanomas affected the head and neck region in 12.3% of patients < 65 years, compared to 28.8% in patient’s ≥65 years, with a significant trend towards more head and neck melanomas with age (p<0.0001). The median Breslow thickness of patients ≥65 years was 3.09mm compared to 1.92mm in patients <65 years, and there was a significant increase in thickness with advancing age (p<0.0001). Older patients had significantly more ulcerated melanomas (p<0.0001, OR = 1.03, 95% CI = 1.02-1.04) and were significantly more likely to have an elevated mitotic rate (p-0.0007, OR = 1.02, 95% CI = 1.03-1.01).
Conclusion: Major differences in the characteristics of melanoma in the elderly compared to younger patients (<65) were seen in this study. The increased proportion of high-risk melanomas should be considered in planning the care of elderly patients.