Unité d'Aide Méthodologique, Hôpital Robert Debré, Reims, France.
JAMA Dermatol. 2013 Oct;149(10):1150-7. doi: 10.1001/jamadermatol.2013.706.
Life expectancy is increasing in most developed countries, and elderly people have the highest incidence of melanoma.
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.
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%]).
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.
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.
在大多数发达国家，预期寿命正在延长，而老年人的黑色素瘤发病率最高。
确定与年轻患者相比，老年患者黑色素瘤的特征及其治疗方法。
设计、地点和参与者：这是一项回顾性基于人群的研究，纳入了 2004 年和 2008 年在法国东北部 5 个地区患有 I 期或 II 期黑色素瘤的 1621 名患者的原发性黑色素瘤的发病情况。通过向医生发放问卷以及对癌症登记处和病理实验室进行调查，获取数据。
与年轻患者（<70 岁，1134 例[70.0%]）相比，老年患者（≥70 岁，487 例[30.0%]）的患者和肿瘤特征、诊断情况以及进一步治疗方法。
老年患者头颈部黑色素瘤（29.4%比 8.7%；P<.001）和结节状、恶性雀斑样痣或肢端雀斑样黑色素瘤组织学亚型的发病率更高。他们的肿瘤更厚，更常发生溃疡，36.7%的病例为 T3 或 T4 期，而年轻患者为 20.1%。黑色素瘤的诊断更常发生在普通诊所，而不是直接咨询皮肤科医生或定期筛查皮肤癌。老年患者明确切除的时间更长，16.8%的患者与年轻患者（5.0%）相比，切除边缘不足（P<.001）。对于厚度大于 1 毫米的老年黑色素瘤患者，23.3%的患者进行了前哨淋巴结活检，而年轻患者中这一比例为 41.4%（P<.001）。老年患者开始辅助治疗的比例较低，且该人群中提前停止辅助治疗的比例更高。
在黑色素瘤管理的每一个步骤都观察到与年龄相关的差异。最重要的问题是老年人能否及时获得早期诊断和适当切缘切除的机会。
