Elderly Age Is Associated With More Conservative Treatment of Invasive Melanoma

Background/Aim: Competing mortality risks complicate treatment of elderly melanoma patients potentially leading to conservative management, including no sentinel lymph node biopsy. As systemic immunotherapy offers justification for nodal evaluation, we examined treatment trends among elderly melanoma patients. Patients and Methods: We performed a National Cancer Database analysis of melanoma patients from 2004-2015. Patients were categorized by age (elderly >= 80-years-old). Multivariable logistic regression analyses were performed comparing characteristics and treatment by age. Results: Of 187,814 patients, 2.7% were 1-25, 11.6% were 26-40, 46.6% were 41-64, 28.8% were 65-79, and 10.3% were >= 80-years-old with clinicopathologic and treatment differences between age cohorts. Nodal surgery was least common among elderly patients (43.1% vs. 60.7-69.8%, p<0.0001). For stage III, immunotherapy was least common among the elderly (p<0.0001), but associated with greater survival (HR=0.52, 95%CI=0.32-0.84, p=0.008). Conclusion: Elderly melanoma patients were often treated conservatively, including no nodal evaluation, concerning for the potential undertreatment of this population.