Age may be a factor in melanoma treatment quality

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Posted on August 26, 2013

People over age 70 diagnosed with melanoma may wait longer to have the malignant spot removed and receive less comprehensive care and monitoring than younger patients, a French study suggests.

“Age-related variations are observed at every step of melanoma management,” lead author Dr. Dragos Ciocan of the Unité d’Aide Méthodologique, Hôpital Robert Debré, Reims, France, and his coauthors write in JAMA Dermatology.

Previous studies have found that older people are less likely to survive melanoma than younger adults, even when their tumor stage at diagnosis is the same.

In the new study, researchers set out to investigate whether care and management of melanoma after diagnosis differs depending on a patient’s age.

Ciocan and his team used questionnaire responses from doctors and data from cancer registries in France to examine 1,621 cases of early-stage melanomas. More than two thirds of the cancers occurred in patients younger than 70.

Twenty-two percent of younger patients waited more than six weeks after diagnosis to have the melanoma removed, compared to 32 percent of the older patients.

There are no standards for a maximum length of time between diagnosis and removal, so waiting longer than six weeks is not necessarily dangerous, but it’s probably not a good idea, said Dr. John G. Albertini, a dermatologist at The Skin Surgery Center in Winston-Salem, North Carolina, who was not involved in the study.

For 17 percent of older patients and 5 percent of younger patients, the actual amount of skin removed by doctors, surgeons or dermatologists was insufficient according to 2004 French surgical guidelines – which require between one and three centimeters of extra margin depending on the thickness of the tumor.

For the thickest and most dangerous melanomas, doctors biopsied a lymph node to check whether the cancer was spreading to other parts of the body in 23 percent of older patients and 41 percent of younger patients.

A general practitioner diagnosed 44 percent of older patients and 34 percent of younger patients, whereas only 4 percent of older patients were diagnosed at regular skin cancer screenings compared to 15 percent of younger patients.

The age-related differences in treatment are probably similar in the U.S., where skin screening is generally not a high priority for older patients, especially those with multiple other complex or chronic health conditions like diabetes, heart disease or emphysema, according to Albertini.

Read more at: HealthDay