Skin Cancer and Ageing
Cancer is more common in elderly patients and melanoma incidence continues to rise predominantly in this population. More than 80% of melanoma deaths occur in patients who are older than 50 years of age, and mortality is specifically increasing in the elderly. Older patients are more likely to suffer from multiple melanocytic and non-melanocytic skin cancers. Melanomas in the elderly more frequently present as aggressive primary lesions, thick primary tumours that predominantly comprise the high-risk primary melanoma stages (Stage IIB-IIC). The overall survival for stage IIB-IIC patients of all ages at 5 years is 60% and 45%, respectively, despite being localised to the skin and non-metastatic at diagnosis. There is a gradual decline in 5-year survival with increasing decades of life, with an almost 20% decrease from ages 60 to 69, to ages greater than 80 years. Additional characteristics of poor prognosis, such as ulceration and elevated mitotic rate, are also more common in the elderly. However, even after taking the main prognostic factors into account there is a survival discrepancy between elderly and young patients, and age is the strongest independent adverse prognostic factor together with tumour thickness.
Understanding the mechanisms that drive poor outcome in the elderly represents a critical current problem in melanoma care. We focus our research on understanding the changes in aged skin that promote melanoma and the biology of aggressive disease affecting the elderly, in order to identify new strategies of adjuvant therapy.
Age-specific melanoma mortality rates. Data prepared by CRUK