Clinicopathologic characteristics and management trends of cutaneous invasive and in situ melanoma in older patients: A retrospective analysis of the National Cancer Data Base

Background: The incidence of melanoma in older patients is on the rise. Prior studies have shown disparities in surgical management and poor survival of older patients with melanoma. Methods: This is a retrospective study of adult patients diagnosed with cutaneous invasive and in situ melanoma between 2000 and 2011 in the National Cancer Data Base. Characteristics and management of older patients (≥60 years) were compared with younger patients (20-59 years) using χ² testing. Results: Of 476,623 total cases, 54% (n = 258,153) were diagnosed among older patients. The reported cases in the older patients increased by 1.74-fold between 2000 and 2011. The majority were white (96%), men (65%), with early-stage disease (76% stage 0-II), and superficial spreading melanoma histology (39%). Older patients, compared with younger patients, were more likely to be men (65% versus 49%, p <0.0001), and have in situ melanoma (28% versus 21%, p <0.0001); less likely to have nodal metastases (7% versus 9%, p <0.0001), receive care in academic centers (30% versus 35%, p <0.0001), undergo wide excision or major amputation for stage I-III disease (68% versus 72%, p <0.0001) and systemic therapy for stage III (18% versus 45%, p <0.0001) and IV disease (30% versus 50%, p <0.0001). Conclusion: Older patients with melanoma are less likely to receive care in academic centers, undergo wide excision for stage I-III disease and receive systemic therapy for stage III-IV disease. Particularly, the utilization of systemic therapy is markedly low. This disparity is particularly important with the availability of less intense more effective therapies.