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Original Investigation |

Distinctive Features of Melanoma and Its Management in Elderly Patients:  A Population-Based Study in France

Dragos Ciocan, MD1; Coralie Barbe, MD1; Francois Aubin, MD, PhD2; Florence Granel-Brocard, MD3; Dan Lipsker, MD, PhD4; Michel Velten, MD, PhD5,6; Sophie Dalac, MD7; François Truchetet, MD8; Catherine Michel, MD9; Audrey Mitschler, MD10; Gwendoline Arnoult, MSc11; Antoine Buemi, MD6,12; Stéphane Dalle, MD, PhD13,14; Philippe Bernard, MD, PhD15; Anne-Sophie Woronoff, MD6,16; Florent Grange, MD, PhD15
[+] Author Affiliations
1Unité d’Aide Méthodologique, Hôpital Robert Debré, Reims, France
2Service de Dermatologie, Hôpital Saint Jacques, Besançon, France
3Service de Dermatologie, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France
4Clinique Dermatologique, Hôpital Civil, Strasbourg, France
5Registre des Cancers du Bas-Rhin, Strasbourg, France
6Réseau Français des Registres de Cancers FRANCIM (France Cancer Incidence et Mortalité), France
7Service de Dermatologie, Hôpital du Bocage, Dijon, France
8Service de Dermatologie, Hôpital Beauregard, Thionville, France
9Service de Dermatologie, Hôpital du Moenschberg, Mulhouse, France
10Service de Dermatologie, Hôpital Louis Pasteur, Colmar, France
11Centre de Recherche et d’Investigation Clinique, Hôpital Maison Blanche, Reims, France
12Registre des Cancers du Haut-Rhin, Mulhouse, France
13Service de Dermatologie du Centre Hospitalier Lyon-Sud, Lyon, France
14Hospices Civils de Lyon, Lyon, France
15Service de Dermatologie, Hôpital Robert Debré, Reims, France
16Registre des tumeurs du Doubs, CHU de Besançon, Besançon, France
JAMA Dermatol. 2013;149(10):1150-1157. doi:10.1001/jamadermatol.2013.706.
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Importance  Life expectancy is increasing in most developed countries, and elderly people have the highest incidence of melanoma.

Objective  To identify characteristics of melanoma and its management in the elderly compared with younger patients.

Design, Setting, and Participants  Retrospective population-based study of incident cases of primary melanoma in 1621 patients with stage I or II melanoma in 2004 and 2008. Questionnaires administered to physicians and a survey of cancer registries and pathology laboratories were used to obtain data. The study was conducted in 5 regions in northeastern France.

Main Outcomes and Measures  Characteristics of patients and tumors, circumstances of diagnosis, and further management in older patients (≥70 years, 487 patients [30.0%]) compared with younger ones (<70 years, 1134 [70.0%]).

Results  Older patients had more frequent melanomas of the head and neck (29.4% vs 8.7%; P < .001) and of the nodular, lentigo maligna, or acral lentiginous histologic subtypes. They had thicker and more frequently ulcerated tumors, categorized as T3 or T4 in 36.7% of cases vs 20.1% in younger patients. Diagnosis of melanoma occurred more frequently in a general practice setting and less frequently in direct consultation with a dermatologist or regular screening for skin cancer. Time to definitive excision was longer in older patients, and 16.8% of them compared with 5.0% of the younger population had insufficient excision margins (P < .001). A sentinel lymph node biopsy was performed in 23.3% of the older patients with melanoma thicker than 1 mm vs 41.4% in the younger patients (P < .001). Adjuvant therapy was less frequently started in older patients and was prematurely stopped in a higher proportion of that population.

Conclusions and Relevance  Age-related variations are observed at every step of melanoma management. The most important concerns are access of elderly people to settings for early diagnosis and excision with appropriate margins.

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