Melanoma Diagnosis and Treatment in the Elderly

Purpose of Review While the overall incidence of melanoma has remained stable in younger populations, the rate of diagnosis in the elderly is rising. Diagnosis and treatment of melanoma presents a major public health challenge for providers, patients, and caretakers. In this paper, we address unique considerations for diagnosis and management of melanoma in the elderly population. Recent Findings There are clinically significant differences in the presentation of melanoma in the elderly. Diagnosis is often delayed, thus screening is crucial and should focus on the atypical presentation of melanoma in this population. Sentinel lymph node biopsy may provide useful prognostic information, although nodal involvement is less likely in the elderly due to age-related changes in lymphatic flow. Several clinical trials have supported the efficacy and better side effect profile of targeted melanoma therapies compared with chemotherapy. Additionally, topical and local treatment, including imiquimod and talimogene laherparepvec, are useful for older patients who cannot tolerate systemic therapy or surgical excision. Summary With a limited number of clinical trials in the elderly, and a steady increase in the incidence of disease, there is a need for development of better diagnostic and management strategies for older patients with melanoma. Elderly patients are underrepresented in clinical trials, and trial outcomes from younger patients may not be directly applicable to an older population. This population requires personalized care and consideration of toxic adverse effects on quality of life.