nach oben

Current Geriatrics Reports

Erschienen in:

11.11.2020 | Dermatology and Wound Care (C Sayed, Section Editor)

Melanoma Diagnosis and Treatment in the Elderly

verfasst von: Kayla M. Babbush, Shadi Damanpour

Erschienen in: Current Geriatrics Reports | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

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 age-related 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.

SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD [available from: https://seer.cancer.gov/csr/1975_2016/. Accessed 26 Aug 2020.

Bulliard JL, Cox B. Cutaneous malignant melanoma in New Zealand: trends by anatomical site, 1969-1993. Int J Epidemiol. 2000;29(3):416–23.PubMed

Marrett LD, Nguyen HL, Armstrong BK. Trends in the incidence of cutaneous malignant melanoma in New South Wales, 1983-1996. Int J Cancer. 2001;92(3):457–62.PubMed

Gaudette LA, Gao RN. Changing trends in melanoma incidence and mortality. Health Rep. 1998;10(2):29–41 (Eng); 33–46 (Fre).PubMed

Chang CK, Jacobs IA, Vizgirda VM, Salti GI. Melanoma in the elderly patient. Arch Surg. 2003;138(10):1135–8.PubMed

Rees MJ, Liao H, Spillane J, Speakman D, McCormack C, Donahoe S, et al. Melanoma in the very elderly, management in patients 85years of age and over. J Geriatr Oncol. 2018;9(5):488–93.PubMed

Ciocan D, Barbe C, Aubin F, Granel-Brocard F, Lipsker D, Velten M, et al. Distinctive features of melanoma and its management in elderly patients: a population-based study in France. JAMA Dermatol. 2013;149(10):1150–7.PubMed

Lasithiotakis K, Leiter U, Meier F, Eigentler T, Metzler G, Moehrle M, et al. Age and gender are significant independent predictors of survival in primary cutaneous melanoma. Cancer. 2008;112(8):1795–804.PubMed

Macdonald JB, Dueck AC, Gray RJ, Wasif N, Swanson DL, Sekulic A, et al. Malignant melanoma in the elderly: different regional disease and poorer prognosis. J Cancer. 2011;2:538–43.PubMedPubMedCentral

10.

Azzola MF, Shaw HM, Thompson JF, Soong SJ, Scolyer RA, Watson GF, et al. Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: an analysis of 3661 patients from a single center. Cancer. 2003;97(6):1488–98.PubMed

11.

Attis MG, Vollmer RT. Mitotic rate in melanoma: a reexamination. Am J Clin Pathol. 2007;127(3):380–4.PubMed

12.

Pan WR, Suami H, Taylor GI. Senile changes in human lymph nodes. Lymphat Res Biol. 2008;6(2):77–83.PubMed

13.

Tsai S, Balch C, Lange J. Epidemiology and treatment of melanoma in elderly patients. Nat Rev Clin Oncol. 2010;7(3):148–52.PubMed

14.

Tsao H, Bevona C, Goggins W, Quinn T. The transformation rate of moles (melanocytic nevi) into cutaneous melanoma: a population-based estimate. Arch Dermatol. 2003;139(3):282–8.PubMed

15.

de Vries E, Nijsten TE, Visser O, Bastiaannet E, van Hattem S, Janssen-Heijnen ML, et al. Superior survival of females among 10,538 Dutch melanoma patients is independent of Breslow thickness, histologic type and tumor site. Ann Oncol. 2008;19(3):583–9.PubMed

16.

Demierre MF, Chung C, Miller DR, Geller AC. Early detection of thick melanomas in the United States: beware of the nodular subtype. Arch Dermatol. 2005;141(6):745–50.PubMed

17.

Kelly JW. Melanoma in the elderly--a neglected public health challenge. Med J Aust. 1998;169(8):403–4.PubMed

18.

Hanrahan PF, Hersey P, D'Este CA. Factors involved in presentation of older people with thick melanoma. Med J Aust. 1998;169(8):410–4.PubMed

19.

Hanrahan PF, Hersey P, Menzies SW, Watson AB, D'Este CA. Examination of the ability of people to identify early changes of melanoma in computer-altered pigmented skin lesions. Arch Dermatol. 1997;133(3):301–11.PubMed

20.

Kelly JW, Chamberlain AJ, Staples MP, McAvoy B. Nodular melanoma. No longer as simple as ABC. Aust Fam Physician. 2003;32(9):706–9.PubMed

21.

Tio D, van der Woude J, Prinsen CAC, Jansma EP, Hoekzema R, van Montfrans C. A systematic review on the role of imiquimod in lentigo maligna and lentigo maligna melanoma: need for standardization of treatment schedule and outcome measures. J Eur Acad Dermatol Venereol. 2017;31(4):616–24.PubMed

22.

Wolf IH, Cerroni L, Kodama K, Kerl H. Treatment of Lentigo Maligna (melanoma in situ) with the immune response modifier Imiquimod. Arch Dermatol. 2005;141(4):510–4.PubMed

23.

Ray CM, Kluk M, Grin CM, Grant-Kels JM. Successful treatment of malignant melanoma in situ with topical 5% imiquimod cream. Int J Dermatol. 2005;44(5):428–34.PubMed

24.

Sladden MJ, Balch C, Barzilai DA, et al. Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev. 2009(4).

25.

Bolognia J, Schaffer J, Cerroni L. Dermatology. 4th edition ed. Amsterdam: Elsevier; 2017.

26.

Testori A, Stanganelli I, Della Grazia L, Mahadavan L. Diagnosis of melanoma in the elderly and surgical implications. Surg Oncol. 2004;13(4):211–21.PubMed

27.

Coit DG, Thompson JA, Albertini MR, et al. Cutaneous melanoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019;17(4):367–402.

28.

Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.PubMedPubMedCentral

29.

Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211–22.PubMedPubMedCentral

30.

Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016;17(6):757–67.PubMed

31.

•• Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer NH, Berking C, et al. Final analysis of DeCOG-SLT trial: no survival benefit for complete lymph node dissection in patients with melanoma with positive sentinel node. J Clin Oncol. 2019;37(32):3000–8 Immediate complete lymph node dissection in melanoma patients with positive sentinel lymph nodes is not superior to observation in regards to overall survival, distant metastasis free survival and relapse free survival and thus is not recommended.PubMed

32.

Bilimoria KY, Balch CM, Wayne JD, Chang DC, Palis BE, Dy SM, et al. Health care system and socioeconomic factors associated with variance in use of sentinel lymph node biopsy for melanoma in the United States. J Clin Oncol. 2009;27(11):1857–63.PubMed

33.

Sabel MS, Kozminski D, Griffith K, Chang AE, Johnson TM, Wong S. Sentinel lymph node biopsy use among melanoma patients 75 years of age and older. Ann Surg Oncol. 2015;22(7):2112–9.PubMed

34.

Shah DR, Yang AD, Maverakis E, Martinez SR. Sentinel lymph node evaluation among elderly melanoma patients: missed opportunities? J Clin Oncol. 2012;30(15_suppl):e19001-e.

35.

Shah DR, Yang AD, Maverakis E, Martinez SR. Age-related disparities in use of completion lymphadenectomy for melanoma sentinel lymph node metastasis. J Surg Res. 2013;185(1):240–4.PubMed

36.

Bilimoria KY, Balch CM, Bentrem DJ, Talamonti MS, Ko CY, Lange JR, et al. Complete lymph node dissection for sentinel node-positive melanoma: assessment of practice patterns in the United States. Ann Surg Oncol. 2008;15(6):1566–76.PubMed

37.

•• Orloff M. Melanoma immunotherapy in the elderly. Curr Oncol Rep. 2018;20(2):20 Immunotherapy has shown great promise for management of melanoma, and there is growing data in support of using these agents in the elderly population. A personalized approach is recommended for use of immune checkpoint inhibitors in this population.PubMed

38.

Buchbinder EI, Desai A. CTLA-4 and PD-1 pathways: similarities, differences, and implications of their inhibition. Am J Clin Oncol. 2016;39(1):98–106.PubMedPubMedCentral

39.

Hurez V, Padron AS, Svatek RS, Curiel TJ. Considerations for successful cancer immunotherapy in aged hosts. Clin Exp Immunol. 2017;187(1):53–63.PubMed

40.

Mian I, Yang M, Zhao H, Shah M, Diab A, Shannon V, et al. Immune-related adverse events and survival in elderly patients with melanoma treated with ipilimumab. J Clin Oncol. 2016;34(15_suppl):3047.

41.

Friedman CF, Horvat TZ, Minehart J, Panageas K, Callahan MK, Chapman PB, et al. Efficacy and safety of checkpoint blockade for treatment of advanced melanoma (mel) in patients (pts) age 80 and older (80+). J Clin Oncol. 2016;34(15_suppl):10009.

42.

Ascierto PA, Kirkwood JM, Grob JJ, Simeone E, Grimaldi AM, Maio M, et al. The role of BRAF V600 mutation in melanoma. J Transl Med. 2012;10:85.PubMedPubMedCentral

43.

• FDA. FDA approves encorafenib and binimetinib in combination for unresectable or metastatic melanoma with BRAF mutations 2018 [Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-encorafenib-and-binimetinib-combination-unresectable-or-metastatic-melanoma-braf. Accessed 26 Aug 2020. The Food and Drug Administration approved the use of encorafenib and binimetinib combination therapy for unresectable or metastatic melanoma with BRAF V600E or V600K mutations.

44.

Liu W, Kelly JW, Trivett M, Murray WK, Dowling JP, Wolfe R, et al. Distinct clinical and pathological features are associated with the BRAF(T1799A(V600E)) mutation in primary melanoma. J Invest Dermatol. 2007;127(4):900–5.PubMed

45.

Shinozaki M, Fujimoto A, Morton DL, Hoon DS. Incidence of BRAF oncogene mutation and clinical relevance for primary cutaneous melanomas. Clin Cancer Res. 2004;10(5):1753–7.PubMed

46.

Bauer J, Büttner P, Murali R, Okamoto I, Kolaitis NA, Landi MT, et al. BRAF mutations in cutaneous melanoma are independently associated with age, anatomic site of the primary tumor, and the degree of solar elastosis at the primary tumor site. Pigment Cell Melanoma Res. 2011;24(2):345–51.PubMedPubMedCentral

47.

Larkin J, Del Vecchio M, Ascierto PA, Krajsova I, Schachter J, Neyns B, et al. Vemurafenib in patients with BRAF(V600) mutated metastatic melanoma: an open-label, multicentre, safety study. Lancet Oncol. 2014;15(4):436–44.PubMed

48.

Chapman PB, Hauschild A, Robert C, Haanen JB, Ascierto P, Larkin J, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011;364(26):2507–16.PubMedPubMedCentral

49.

Robert C, Long GV, Brady B, Dutriaux C, Maio M, Mortier L, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med. 2015;372(4):320–30.PubMed

50.

Ma C, Armstrong AW. Severe adverse events from the treatment of advanced melanoma: a systematic review of severe side effects associated with ipilimumab, vemurafenib, interferon alfa-2b, dacarbazine and interleukin-2. J Dermatol Treat. 2014;25(5):401–8.

51.

Hunter CP, Johnson KA, Muss HB. Cancer in the elderly. Boca Raton, Florida, USA: Taylor & Francis Group; 2000.

52.

Tarhini AA, Kirkwood JM. Clinical and immunologic basis of interferon therapy in melanoma. Ann N Y Acad Sci. 2009;1182:47–57.PubMedPubMedCentral

53.

Kirkwood JM, Ibrahim JG, Sosman JA, Sondak VK, Agarwala SS, Ernstoff MS, et al. High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma: results of intergroup trial E1694/S9512/C509801. J Clin Oncol. 2001;19(9):2370–80.PubMed

54.

Kirkwood JM, Strawderman MH, Ernstoff MS, Smith TJ, Borden EC, Blum RH. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol. 1996;14(1):7–17.PubMed

55.

Garbe C, Radny P, Linse R, Dummer R, Gutzmer R, Ulrich J, et al. Adjuvant low-dose interferon {alpha}2a with or without dacarbazine compared with surgery alone: a prospective-randomized phase III DeCOG trial in melanoma patients with regional lymph node metastasis. Ann Oncol. 2008;19(6):1195–201.PubMed

56.

Grob JJ, Dreno B, de la Salmoniere P, Delaunay M, Cupissol D, Guillot B, et al. Randomised trial of interferon alpha-2a as adjuvant therapy in resected primary melanoma thicker than 1.5 mm without clinically detectable node metastases. French Cooperative Group on Melanoma. Lancet. 1998;351(9120):1905–10.PubMed

57.

Pehamberger H, Soyer HP, Steiner A, Kofler R, Binder M, Mischer P, et al. Adjuvant interferon alfa-2a treatment in resected primary stage II cutaneous melanoma. Austrian Malignant Melanoma Cooperative Group. J Clin Oncol. 1998;16(4):1425–9.PubMed

58.

Wheatley K, Ives N, Eggermont A, Kirkwood J, Cascinelli N, Markovic SN, et al. Interferon-α as adjuvant therapy for melanoma: An individual patient data meta-analysis of randomised trials. J Clin Oncol. 2007;25(18_suppl):8526.

59.

Hauschild A, Gogas H, Tarhini A, Middleton MR, Testori A, Dréno B, et al. Practical guidelines for the management of interferon-α-2b side effects in patients receiving adjuvant treatment for melanoma. Cancer. 2008;112(5):982–94.PubMed

60.

Broman KK, Zager JS. An evaluation of talimogene laherparepvec for the treatment of melanoma. Expert Opin Biol Ther. 2020;20(1):9–14.PubMed

61.

• Haitz K, Khosravi H, Lin JY, Menge T, Nambudiri VE. Review of talimogene laherparepvec: A first-in-class oncolytic viral treatment of advanced melanoma. J Am Acad Dermatol. 2020;83(1):189–96. A number of clinical trials have demonstrated the efficacy of intralesional treatment of advanced melanoma with T-VEC, and this oncolytic virotherapy is a promising local melanoma therapy.

62.

Rehman H, Silk AW, Kane MP, Kaufman HL. Into the clinic: talimogene laherparepvec (T-VEC), a first-in-class intratumoral oncolytic viral therapy. J Immunother Cancer. 2016;4:53.PubMedPubMedCentral

63.

Naqash AR, Stroud G, Collichio FA, Muzaffar M, Sharma N, Walker P. Metastatic melanoma in a 95 years old patient responding to treatment with talimogene laherparepvec followed by nivolumab. Acta Oncol. 2017;56(10):1327–30.PubMed

64.

Schvartsman G, Perez K, Flynn JE, Myers JN, Tawbi H. Safe and effective administration of T-VEC in a patient with heart transplantation and recurrent locally advanced melanoma. J Immunother Cancer. 2017;5:45.PubMedPubMedCentral

65.

Blackmon JT, Stratton MS, Kwak Y, Pavlidakey PG, Slominski AT, McKee SB, et al. Inflammatory melanoma in transit metastases with complete response to talimogene laherparepvec. JAAD Case Rep. 2017;3(4):280–3.PubMedPubMedCentral

66.

Hegde UP, Chakraborty N, Kerr P, Grant-Kels JM. Melanoma in the elderly patient: relevance of the aging immune system. Clin Dermatol. 2009;27(6):537–44.PubMed

Titel: Melanoma Diagnosis and Treatment in the Elderly
verfasst von: Kayla M. Babbush
Shadi Damanpour
Publikationsdatum: 11.11.2020
Verlag: Springer US
Erschienen in: Current Geriatrics Reports / Ausgabe 4/2020
Elektronische ISSN: 2196-7865
DOI: https://doi.org/10.1007/s13670-020-00330-w

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2020

Dermatologic Manifestations of Nutritional Deficiency

Venous Stasis Ulcers: an Update on Diagnosis and Management

Xerosis Cutis in the Aging Population: an Approach to Diagnosis and Treatment

Diet, Microbioma, and Diabetes in Aging

Effect of Prehabilitation in Older Adults Undergoing Total Joint Replacement: an Overview of Systematic Reviews