Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 Nov;20(12):3961-8.
doi: 10.1245/s10434-013-3100-9. Epub 2013 Jul 10.

Age as a prognostic factor in patients with localized melanoma and regional metastases

Charles M Balch  1 , Seng-jaw Soong, Jeffrey E Gershenwald, John F Thompson, Daniel G Coit, Michael B Atkins, Shouluan Ding, Alistair J Cochran, Alexander M M Eggermont, Keith T Flaherty, Phyllis A Gimotty, Timothy M Johnson, John M Kirkwood, Stanley P Leong, Kelly M McMasters, Martin C Mihm Jr, Donald L Morton, Merrick I Ross, Vernon K Sondak
Affiliations
Comparative Study

Age as a prognostic factor in patients with localized melanoma and regional metastases

Charles M Balch et al. Ann Surg Oncol. 2013 Nov.

Abstract

Background: We postulated that the worse prognosis of melanoma with advancing age reflected more aggressive tumor biology and that in younger patients the prognosis would be more favorable.

Materials and methods: The expanded AJCC melanoma staging database contained 11,088 patients with complete data for analysis, including mitotic rate.

Results: With increasing age by decade, primary melanomas were thicker, exhibited higher mitotic rates, and were more likely to be ulcerated. In a multivariate analysis of patients with localized melanoma, thickness and ulceration were highly significant predictors of outcome at all decades of life (except for patients younger than 20 years). Mitotic rate was significantly predictive in all age groups except patients <20 and >80 years. For patients with stage III melanoma, there were four independent variables associated with patient survival: number of nodal metastases, patient age, ulceration, and mitotic rate. Patients younger than 20 years of age had primary tumors with slightly more aggressive features, a higher incidence of sentinel lymph node metastasis, but, paradoxically, more favorable survival than all other age groups. In contrast, patients >70 years old had primary melanomas with the most aggressive prognostic features, were more likely to be head and neck primaries, and were associated with a higher mortality rate than the other age groups. Surprisingly, however, these patients had a lower rate of sentinel lymph node metastasis per T stage. Among patients between the two age extremes, clinicopathologic features and survival tended to be more homogeneous.

Conclusions: Melanomas in patients at the extremes of age have a distinct natural history.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A: Mean thickness of the primary melanoma according to age of patients with localized tumors (stages I/II) or regional nodal metastases (stage III) F-test based on a mixed model: stage difference, F(1,7)=322.2, P<0.0001; Age difference: F(7,7)=19.2, P=0.0005 B: Mean mitotic rate in patients with localized melanoma (Stages I and II) and those with regional nodal metastases (Stage III) sorted by patient age by decade. F-test based on a mixed model: stage difference, F(1,7)=268.3, P<0.0001; Age difference: F(7,7)=30.4, P=0.0001
Figure 2
Figure 2
A: Incidence of primary melanoma ulceration in patients with localized melanoma (Stages I and II) and those with regional nodal metastases (Stage III) by patient age. F-test based on a mixed model: stage difference, F(1,7)=1284.1, P<0.0001; Age difference: F(7,7)=69.6, P<0.0001 B: Incidence of head and neck melanoma in patients with localized disease (Stages I and II) and those with regional nodal metastases (Stage III) by patient age. F-test based on a mixed model: stage difference, F(1,7)=2.1, P=0.1924; Age difference: F(7,7)=3.9, P=0.0470 C: Incidence of trunk melanoma in patients with localized disease (Stages I and II) and those with regional nodal metastases (Stage III) sorted by patient age. F-test based on a mixed model: stage difference, F(1,7)=2.2, P=0.1787; Age difference: F(7,7)=23.6, P=0.0002
Figure 3
Figure 3
A. Survival curves by age of patients with stage I/II melanoma B Survival curves by age of patients with stage III melanoma
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–6206. - PMC - PubMed
    1. Balch CM, Gershenwald JE, Soong SJ, et al. Multivariate analysis of prognostic factors among 2,313 patients with stage III melanoma: comparison of nodal micrometastases versus macrometastases. J Clin Oncol. 2010;28:2452–2459. - PMC - PubMed
    1. Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19:3622–3634. - PubMed
    1. Balch CM, Soong SJ, Milton GW, et al. A comparison of prognostic factors and surgical results in 1,786 patients with localized (stage I) melanoma treated in Alabama, USA, New South Wales, Australia. Ann Surg. 1982;196:677–684. - PMC - PubMed
    1. Balch CM, Soong SJ, Murad TM, et al. A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma. Surgery. 1979;86:343–351. - PubMed

Publication types

MeSH terms