Distinctive features of melanoma and its management in elderly patients: a population-based study in France.
| Autor: | Ciocan D; Unité d'Aide Méthodologique, Hôpital Robert Debré, Reims, France., Barbe C, Aubin F, Granel-Brocard F, Lipsker D, Velten M, Dalac S, Truchetet F, Michel C, Mitschler A, Arnoult G, Buemi A, Dalle S, Bernard P, Woronoff AS, Grange F |
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| Jazyk: | angličtina |
| Zdroj: | JAMA dermatology [JAMA Dermatol] 2013 Oct; Vol. 149 (10), pp. 1150-7. |
| DOI: | 10.1001/jamadermatol.2013.706 |
| Abstrakt: | Importance: Life expectancy is increasing in most developed countries, and elderly people have the highest incidence of melanoma. Objective: To identify characteristics of melanoma and its management in the elderly compared with younger patients. Design, Setting, and Participants: Retrospective population-based study of incident cases of primary melanoma in 1621 patients with stage I or II melanoma in 2004 and 2008. Questionnaires administered to physicians and a survey of cancer registries and pathology laboratories were used to obtain data. The study was conducted in 5 regions in northeastern France. Main Outcomes and Measures: Characteristics of patients and tumors, circumstances of diagnosis, and further management in older patients (≥70 years, 487 patients [30.0%]) compared with younger ones (<70 years, 1134 [70.0%]). Results: Older patients had more frequent melanomas of the head and neck (29.4% vs 8.7%; P < .001) and of the nodular, lentigo maligna, or acral lentiginous histologic subtypes. They had thicker and more frequently ulcerated tumors, categorized as T3 or T4 in 36.7% of cases vs 20.1% in younger patients. Diagnosis of melanoma occurred more frequently in a general practice setting and less frequently in direct consultation with a dermatologist or regular screening for skin cancer. Time to definitive excision was longer in older patients, and 16.8% of them compared with 5.0% of the younger population had insufficient excision margins (P < .001). A sentinel lymph node biopsy was performed in 23.3% of the older patients with melanoma thicker than 1 mm vs 41.4% in the younger patients (P < .001). Adjuvant therapy was less frequently started in older patients and was prematurely stopped in a higher proportion of that population. Conclusions and Relevance: Age-related variations are observed at every step of melanoma management. The most important concerns are access of elderly people to settings for early diagnosis and excision with appropriate margins. |
| Databáze: | MEDLINE |
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