Morris B T, Sober A J
Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
Clin Geriatr Med. 1989 Feb;5(1):171-81.
Malignant melanoma can be a devastating disease, especially in the elderly patient. These patients may be affected by types of malignant melanoma that are seen less frequently in younger patients, namely lentigo maligna melanoma and acral lentiginous melanoma. In patients with stage I disease, age per se does not correlate directly with prognosis. However, tumor thickness does correlate directly with prognosis, and because elderly patients tend to present with thicker lesions, they have prognostically poorer outcomes. Currently one can only speculate as to why the elderly have on average thicker lesions. Surgical excision continues to be the treatment of choice for malignant melanoma. Many elderly patients are not able to tolerate more invasive procedures, such as lymph-node dissections. At this point, the physician should work with the patient and the patient's family to assess the need of each and to develop a clear medical plan. One should maintain an optimistic attitude in dealing with malignant melanoma in elderly patients. Although much work remains to be done with regard to developing new, effective therapies, even today the majority of elderly patients with malignant melanoma will not die from their disease.
恶性黑色素瘤可能是一种极具毁灭性的疾病，尤其是在老年患者中。这些患者可能会受到在年轻患者中较少见的恶性黑色素瘤类型的影响，即恶性雀斑样痣黑色素瘤和肢端雀斑样痣黑色素瘤。在I期疾病患者中，年龄本身与预后并无直接关联。然而，肿瘤厚度确实与预后直接相关，并且由于老年患者往往表现为较厚的病灶，他们的预后较差。目前，人们只能推测为何老年人的病灶平均更厚。手术切除仍然是恶性黑色素瘤的首选治疗方法。许多老年患者无法耐受更具侵入性的手术，如淋巴结清扫术。此时，医生应与患者及其家属合作，评估各自的需求并制定明确的医疗计划。在处理老年患者的恶性黑色素瘤时应保持乐观态度。尽管在开发新的有效疗法方面仍有许多工作要做，但即使在今天，大多数老年恶性黑色素瘤患者也不会死于该疾病。
