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Age as a Prognostic Factor in Patients with Localized Melanoma and Regional Metastases

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We postulated that the worse prognosis of melanoma with advancing age reflected more aggressive tumor biology and that in younger patients the prognosis would be more favorable.

Materials and Methods

The expanded AJCC melanoma staging database contained 11,088 patients with complete data for analysis, including mitotic rate.

Results

With increasing age by decade, primary melanomas were thicker, exhibited higher mitotic rates, and were more likely to be ulcerated. In a multivariate analysis of patients with localized melanoma, thickness and ulceration were highly significant predictors of outcome at all decades of life (except for patients younger than 20 years). Mitotic rate was significantly predictive in all age groups except patients <20 and >80 years. For patients with stage III melanoma, there were four independent variables associated with patient survival: number of nodal metastases, patient age, ulceration, and mitotic rate. Patients younger than 20 years of age had primary tumors with slightly more aggressive features, a higher incidence of sentinel lymph node metastasis, but, paradoxically, more favorable survival than all other age groups. In contrast, patients >70 years old had primary melanomas with the most aggressive prognostic features, were more likely to be head and neck primaries, and were associated with a higher mortality rate than the other age groups. Surprisingly, however, these patients had a lower rate of sentinel lymph node metastasis per T stage. Among patients between the two age extremes, clinicopathologic features and survival tended to be more homogeneous.

Conclusions

Melanomas in patients at the extremes of age have a distinct natural history.

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Acknowledgment

The study of the AJCC/UICC Melanoma Staging Committee was supported by a grant from the American Joint Committee on Cancer and by grants from the National Cancer Institute (P30 CA13148 at the University of Alabama at Birmingham and P50 CA93459 SPORE grant in melanoma at The University of Texas M.D. Anderson Cancer Center in Houston, TX). Three meetings held by the Committee were partially supported by an unrestricted educational grant from Schering-Plough (Kenilworth, NJ). The authors thank Ms. Gwen Berry at the John Wayne Cancer Institute for her editorial assistance.

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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Charles M. Balch MD

  2. University of Alabama at Birmingham, Birmingham, AL, USA

    Seng-jaw Soong PhD

  3. Department of Surgical Oncology, UTMD Anderson Cancer Center, Houston, TX, USA

    Jeffrey E. Gershenwald MD & Merrick I. Ross MD

  4. Melanoma Institute Australia, North Sydney, NSW, Australia

    John F. Thompson MD

  5. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Daniel G. Coit MD

  6. Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC, USA

    Michael B. Atkins MD

  7. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

    Shouluan Ding PhD

  8. Departments of Pathology and Laboratory Medicine, UCLA School of Medicine, Los Angeles, CA, USA

    Alistair J. Cochran MD

  9. Cancer Institute Gustave Roussy, Villejuif, France

    Alexander M. M. Eggermont MD

  10. Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Keith T. Flaherty MD

  11. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA

    Phyllis A. Gimotty PhD

  12. Department of Dermatology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

    Timothy M. Johnson MD

  13. Division of Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    John M. Kirkwood MD

  14. Department of Surgery, California Pacific Medical Center and Research Institute, San Francisco, CA, USA

    Stanley P. Leong MD

  15. Department of Surgery, University of Louisville, Louisville, KY, USA

    Kelly M. McMasters MD

  16. Department of Pathology, Dana Farber cancer Institute, Boston, MA, USA

    Martin C. Mihm Jr. MD

  17. John Wayne Cancer Institute, Santa Monica, CA, USA

    Donald L. Morton MD

  18. Division of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Vernon K. Sondak MD

Authors
  1. Charles M. Balch MD
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  2. Seng-jaw Soong PhD
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  3. Jeffrey E. Gershenwald MD
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  4. John F. Thompson MD
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  8. Alistair J. Cochran MD
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  9. Alexander M. M. Eggermont MD
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  12. Timothy M. Johnson MD
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  14. Stanley P. Leong MD
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  17. Donald L. Morton MD
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  18. Merrick I. Ross MD
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  19. Vernon K. Sondak MD
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Corresponding author

Correspondence to Charles M. Balch MD.

Additional information

Seng-jaw Soong—deceased.

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Balch, C.M., Soong, Sj., Gershenwald, J.E. et al. Age as a Prognostic Factor in Patients with Localized Melanoma and Regional Metastases. Ann Surg Oncol 20, 3961–3968 (2013). https://doi.org/10.1245/s10434-013-3100-9

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  • DOI: https://doi.org/10.1245/s10434-013-3100-9

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