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Melanoma in the very elderly, management in patients 85years of age and over

机译:黑色素瘤在非常老年人,患者的管理85年龄及以上

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ObjectivesMelanoma treatment in the elderly can entail complex decision making. This study characterizes the presentation, management, and outcome of melanoma in the very elderly. MethodRetrospective review of all patients in their 85th year or older presenting to a tertiary referral cancer centre between 2000 and 2012 with American Joint Committee on Cancer stages 0–II cutaneous melanoma. Results127 patients, 26 with in-situ disease and 101 with stages I–II disease, were included. For invasive primary disease, the median age was 87years (IRQ=86–89). Most patients had melanomas with poor prognoses at diagnosis: 49.5% were ulcerated, 68.3% mitotically active (mitotic rate≥1), and the median tumor thickness was 3.7mm (IQR=1.7–5.8). Nodular melanomas were the most frequent subtype (31.7%, 32/101). Only 66.3% received an excision margin≥10mm. Suboptimal excision margins were associated with increased risk of local recurrence (HR=6.87, 95% CI=5.53–8.20, p=0.0045) but not poorer disease specific survival (DSS, p=0.37) or overall survival (OS, p=0.19). Sentinel node biopsy (SNB) did not influence survival (DSS, p=0.39, OS, p=0.78). Median OS was 33months. Overall, one-third (34.7%) of patients died from causes other than melanoma during the follow up period. In patients aged ≥90 only 1 patient (4.3%) died from melanoma, while 10 patients (43.5%) died of other causes. ConclusionsOlder patients have thick, mitotically active and frequently ulcerated melanomas. An excision margin≥10mm should be considered to reduce risk of local recurrence. SNB did not impact on survival. With increasing age, patients will more commonly die of causes other than melanoma regardless of the extent of surgical care.
机译:老年人的玻璃瘤治疗可能需要复杂的决策。本研究表征了非常老年黑色素瘤的介绍,管理和结果。在2000年至2012年与美国联合癌症阶段0-II皮肤黑色素瘤中,在2000年至2012年期间,在85年或更年纪大的所有患者的方法审查所有患者的审查。结果127例患者,26例,具有原位疾病和101例,具有阶段I-II疾病。对于侵袭性原发性疾病,中位年龄为87年(IRQ = 86-89)。大多数患者在诊断中患有差的患者,溃疡较差,溃疡较低,有明显的有明显(有丝分裂率≥1),中位肿瘤厚度为3.7mm(IQR = 1.7-5.8)。结节黑色素瘤是最常见的亚型(31.7%,32/101)。只有66.3%的收到切除边缘≥10mm。次优切除余量与局部复发的风险增加有关(HR = 6.87,95%CI = 5.53-8.20,P = 0.0045),但不较差的疾病特异性存活(DSS,P = 0.37)或整体存活(OS,P = 0.19 )。 Sentinel节点活检(SNB)没有影响生存率(DSS,P = 0.39,OS,P = 0.78)。中位数操作系统是33个月。总体而言,三分之一(34.7%)患者在后续期间死于黑色素瘤以外的原因。在≥90岁的患者中,仅1名患者(4.3%)死于黑素瘤,而10名患者(43.5%)死于其他原因。结论升级患者具有厚,有明显的活性和经常溃疡的黑色素瘤。应考虑切除距离≥10mm以降低局部复发的风险。 SNB没有影响生存。随着年龄的增加,无论手术护理的程度如何,患者都会更常见于黑色素瘤以外的原因。

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