MANCHESTER, ENGLAND – Men over the age of 60 years have the highest incidence of malignant melanoma, European data have highlighted.
In the Netherlands, almost 40% of men and 30% of women with newly diagnosed melanoma are over 60 years old, said Dr. Maryska Janssen-Heijnen of VieCuri Medical Centre in Venlo, the Netherlands.
"Future screening campaigns should focus on the elderly, and especially elderly men, because we have seen a very strong increase in incidence," she said at the annual meeting of the International Society of Geriatric Oncology.
A similar situation exists in England, with 30 years’ worth of data from the Office for National Statistics showing a greater proportion of melanoma being diagnosed in people over age 70.
"Older patients tend to present with worse prognostic features – ulceration, high mitotic rate, thicker melanomas, and head and neck distribution being more likely," said Dr. Alistair Ring of Brighton and Sussex Medical School, Brighton, England.
Dr. Ring presented data on all new cases of melanoma reported in England from 1971 to 2010. In 1971, there were 1,094 malignant melanoma registrations – 32% were in men. In 2009, there were 9,771 registrations – 48% were in men.
Looking at incidence by age, the number of registrations in men versus women in 1971 was lower: 33 vs. 64 cases at age 60-64 years, 23 vs. 59 cases at age 65-70, 30 vs. 43 at age 70-74, and 16 vs. 46 at age 75-79 years.
In 2009, however, the number of registrations was higher in men than in women at 60-64 years (637 vs. 592 cases), 65-69 years (580 vs. 460 cases), 70-74 years (562 vs. 429 cases), and 75-79 years (499 vs. 397).
The incidence of melanoma in Holland between 1989 and 2010 was stable for people aged 15-29 years, Dr. Janssen-Heijnen said, with women more likely to be diagnosed than men. The incidence of melanoma has increased among all patients under age 60, but the rate has increased to a greater extent in older patients, particularly in men.
Campaigns to make the public aware about the risk of sun exposure and skin cancer have perhaps helped to encourage screening and reduce melanoma rates in younger people, but the effect appears to have been minimal in the elderly, Dr. Janssen-Heijnen said.
Overall survival also is worse in older than in younger individuals. The poorer survival in elderly might be due to an increased proportion of nodular melanomas in older patients and the development of the disease without early signs and symptoms. Elderly patients also might be less attentive to skin changes and less likely than their younger counterparts to perform self-examinations, she suggested.
The Dutch study found thick (greater than 4 mm) melanomas in 20% of men and 8% of women over age 65 with melanoma. Thick lesions were noted in 16% of men and 5% of women under age 65 with melanoma.
Older patients are also more likely than younger patients to have comorbid conditions, said Dr. Janssen-Heijnen, with 70% of men and 70% of women aged 80 years or older having one or more comorbid conditions at diagnosis of melanoma, versus 28% of men and 23% of women aged 50–64 years.
Recently published data suggest that patients are more likely to die of comorbidity than of their melanoma (Aust. N. Z. J. Public Health 2012;36:441-5).
Dr. Ring also presented data on 454 patients newly diagnosed with melanoma at his institution between 2001 and 2006; almost half (48%) were aged 60 years or older.
"Older patients were more likely to present with more advanced disease," Dr. Ring said. Indeed, 22% of patients aged over 60 years, versus just 8.5% of patients younger than 60 years, were newly diagnosed with stage IIb or stage III disease (P less than .01).
Dr. Ring noted, however, that 67% of patients aged 60 years or older with stage IIb melanoma had no comorbidities (Charlson Comorbidity Index of 0).
"What is important about [these data] is that we’ve got a lot of [older] people with a high risk of recurrence with potentially a low risk of dying from other causes," he commented.
This has implications for enrollment into adjuvant therapy trials, as these patients may represent a population of patients with good potential to respond to recently available targeted agents.
Dr. Janssen-Heijnen and Dr. Ring had no financial disclosures relevant to their presentations.