Melanoma Diagnosis and Treatment in the Elderly
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DERMATOLOGY AND WOUND CARE (C SAYED, SECTION EDITOR)
Melanoma Diagnosis and Treatment in the Elderly Kayla M. Babbush 1 & Shadi Damanpour 1 Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review While the overall incidence of melanoma has remained stable in younger populations, the rate of diagnosis in the elderly is rising. Diagnosis and treatment of melanoma presents a major public health challenge for providers, patients, and caretakers. In this paper, we address unique considerations for diagnosis and management of melanoma in the elderly population. Recent Findings There are clinically significant differences in the presentation of melanoma in the elderly. Diagnosis is often delayed, thus screening is crucial and should focus on the atypical presentation of melanoma in this population. Sentinel lymph node biopsy may provide useful prognostic information, although nodal involvement is less likely in the elderly due to agerelated changes in lymphatic flow. Several clinical trials have supported the efficacy and better side effect profile of targeted melanoma therapies compared with chemotherapy. Additionally, topical and local treatment, including imiquimod and talimogene laherparepvec, are useful for older patients who cannot tolerate systemic therapy or surgical excision. Summary With a limited number of clinical trials in the elderly, and a steady increase in the incidence of disease, there is a need for development of better diagnostic and management strategies for older patients with melanoma. Elderly patients are underrepresented in clinical trials, and trial outcomes from younger patients may not be directly applicable to an older population. This population requires personalized care and consideration of toxic adverse effects on quality of life. Keywords Melanoma . Skin cancer . Malignancy . Elderly patients . Geriatric patients . Diagnosis . Disease management
Introduction According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, there has been a steady increase in melanoma diagnoses since the 1970s [1]. The overall incidence of melanoma seems to be stable or even declining in younger populations, yet the rate of diagnosis in the elderly continues to rise [2–5]. When considering age-adjusted rates, the incidence of melanoma is more than seven times greater in the age 65 and older population, compared with those under 65 years old. Additionally, the 5-year relative survival is lower in the elderly population [1] . Rees et al. proposed that in elderly patients with melanoma, medical decision-making is complicated by patient frailty, This article is part of the Topical Collection on Dermatology and Wound Care * Shadi Damanpour [email protected] 1
Division of Dermatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Avenue, Second Floor, Bronx, NY 10467, USA
alternative causes of mortality, numerous comorbidities, and reluctance of bot
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