Melanoma in older patients: declining gap in survival between younger and older patients with melanoma

Figures & data

Figure 1. Age-standardized incidence rates of cutaneous melanoma, by age category and sex (1989–2015).

Rates are age-standardized using the 2000 Dutch Population. CI: confidence interval; EAPC: estimated annual percentage change.

Table 1. General characteristics of patients diagnosed with cutaneous melanoma in the Netherlands, by age category and sex (2003–2015).

	Men					Women
	Age category				p Value	Age category				p Value
	<70 years	70–79 years	80–89 years	≥90 years		<70 years	70–79 years	80–89 years	≥90 years
	N (%)	N (%)	N (%)	N (%)		N (%)	N (%)	N (%)	N (%)
N	18,793	4663	1995	233		23,681	4341	2377	463
Breslow thickness					<.001					<.001
<1 mm	9845 (52.4)	2099 (45.0)	741 (37.1)	66 (28.2)		14,815 (62.6)	2087 (48.1)	789 (33.2)	93 (20.1)
1.01–2 mm	4233 (22.5)	931 (20.0)	338 (16.9)	29 (12.5)		5153 (21.8)	927 (21.4)	469 (19.7)	65 (14.0)
2.01–4 mm	2608 (13.9)	857 (18.4)	415 (20.8)	53 (22.8)		2182 (9.2)	714 (16.5)	521 (21.9)	115 (24.8)
>4 mm	1413 (7.5)	579 (12.4)	375 (18.8)	73 (31.3)		800 (3.4)	467 (10.8)	472 (19.9)	150 (32.4)
Unknown	694 (3.7)	197 (4.2)	126 (6.3)	12 (5.2)		731 (3.1)	146 (3.4)	126 (5.3)	40 (8.6)
Lymph nodes status					<.001					<.001
N0	12,783 (68.0)	3229 (69.3)	1314 (65.9)	150 (64.4)		16,553 (69.9)	3018 (69.5)	1581 (66.5)	268 (57.9)
N+	1871 (10.0)	387 (8.3)	160 (8.0)	12 (5.2)		1326 (5.6)	283 (6.5)	174 (7.3)	42 (9.1)
Unknown	4139 (22.1)	1047 (22.5)	521 (26.2)	71 (30.5)		5802 (24.5)	1040 (24.0)	622 (26.2)	153 (33.1)
Distant metastasis at diagnosis					.12					<.001
No	18,552 (98.7)	4585 (98.3)	1961 (98.3)	230 (98.7)		23,554 (99.5)	4297 (99.0)	2336 (98.2)	454 (98.1)
Yes	241 (1.3)	78 (1.7)	34 (1.7)	3 (1.3)		127 (0.5)	44 (1.0)	41 (1.7)	9 (1.9)
Histological subtype					<.001					<.001
SSM	13,255 (70.5)	2808 (60.2)	938 (47.0)	89 (38.2)		17,675 (74.6)	2556 (58.9)	1094 (46.0)	140 (30.2)
NM	2266 (12.1)	744 (16.0)	400 (20.1)	66 (28.3)		2132 (9.0)	657 (15.1)	497 (20.9)	121 (26.1)
LMM	450 (2.4)	378 (8.1)	270 (13.5)	33 (14.2)		516 (2.2)	425 (9.8)	339 (14.3)	75 (16.2)
Other/unspecified	2822 (15.0)	733 (15.7)	387 (19.4)	4 (19.3)		3358 (14.2)	703 (16.2)	447 (18.8)	127 (27.4)
Tumor localization					<.001					<.001
Head/neck	2272 (12.1)	1021 (21.9)	775 (38.9)	135 (57.9)		1748 (7.4)	769 (17.7)	650 (27.4)	180 (38.9)
Trunk	10,087 (53.7)	2186 (46.9)	653 (32.7)	56 (24.0)		7731 (32.7)	793 (18.3)	286 (12.0)	41 (8.9)
Upper limbs	3393 (18.1)	884 (19.0)	354 (17.7)	23 (9.9)		5256 (22.2)	1219 (28.1)	636 (26.8)	117 (25.3)
Lower limbs	2999 (16.0)	558 (12.0)	205 (10.3)	17 (7.3)		8891 (37.5)	1549 (35.7)	800 (33.7)	124 (26.8)
Unknown	42 (0.2)	14 (0.3)	8 (0.4)	2 (0.9)		55 (0.2)	11 (0.3)	5 (0.2)	1 (0.2)
TNM stage (6th and 7th ed.)					<.001					<.001
I	13,139 (70.2)	2857 (61.3)	1022 (51.2)	86 (36.9)		19,152 (80.9)	2841 (65.5)	1166 (49.1)	140 (30.2)
II	3255 (17.3)	1261 (27.0)	723 (36.2)	121 (51.9)		2717 (11.5)	1099 (25.3)	937 (39.4)	244 (52.7)
III	1715 (9.1)	351 (7.5)	140 (7.0)	12 (5.2)		1237 (5.2)	260 (6.0)	153 (6.4)	39 (8.4)
IV	241 (1.3)	78 (1.7)	34 (1.7)	3 (1.3)		127 (0.5)	44 (1.0)	41 (1.7)	9 (1.9)
X	389 (2.1)	116 (2.5)	76 (3.8)	11 (4.7)		448 (1.9)	97 (2.2)	80 (3.4)	31 (6.7)
Period of diagnosis^a					<.001					<.001
2003–2009	8449 (77.9)	1660 (15.3)	679 (6.3)	58 (0.5)		11,139 (78.6)	1842 (13.0)	993 (7.0)	196 (1.4)
2010–2015	10,344 (69.7)	3003 (20.3)	1316 (8.9)	175 (1.2)		12,542 (75.1)	2499 (15.0)	1384 (8.3)	267 (1.6)
Subgroup analysis
Number of comorbidities^b					<.001					<.001
None	1435 (62.2)	144 (24.3)	33 (16.4)	2 (7.1)		2028 (68.9)	197 (36.8)	61 (24.7)	13 (24.1)
1 comorbidity	388 (16.8)	156 (26.3)	40 (19.9)	6 (21.4)		403 (13.7)	151 (28.2)	68 (27.5)	17 (31.5)
≥2 comorbidities	220 (9.5)	236 (39.8)	119 (59.2)	19 (67.9)		152 (5.2)	133 (24.9)	93 (37.7)	20 (37.0)
Unknown	265 (11.5)	57 (9.6)	9 (4.5)	1 (3.6)		359 (12.2)	54 (10.1)	25 (10.1)	4 (7.4)

^a Row percentages are presented (instead of column percentages).

^b Data only available for a subgroup of the total study population (n = 6908, 12% of the total study population).

Abbreviations: LMM: lentigo maligna melanoma; NM: nodular melanoma; SSM: superficial spreading melanoma.

Table 2. Patient and tumor characteristics of older cutaneous melanoma patients (aged ≥ 70 years), by the period of diagnosis.

	Men					Women
	2003–2009		2010–2015		p Value	2003–2009		2010–2015		p Value
	N	%	N	%		N	%	N	%
N	2397		4494			3031		4150
Median age in years arsywyears (IQR)	76 (73–81)		76 (73–81)		.13	78 (73–83)		77 (73–83)		.70
Breslow thickness					<.001					<.001
<1 mm	856	35.7	2050	45.6		1104	36.4	1865	44.9
1.01–2 mm	460	19.2	838	18.7		626	20.7	835	20.1
2.01–4 mm	507	21.2	818	18.2		583	19.2	767	18.5
>4mm	433	18.1	594	13.2		549	18.1	540	13.0
Unknown	141	5.9	194	4.3		169	5.6	143	3.5
Lymph node status					<.001					<.001
N0	1508	62.9	3185	70.9		1902	62.8	2965	71.5
N+	206	8.6	353	7.9		220	7.3	279	6.7
Unknown	683	28.5	956	21.3		909	30.0	906	21.8
Distant metastasis					.32					.03
No	2352	98.1	4424	98.4		2981	98.4	4106	98.9
Yes	45	1.9	70	1.6		50	1.7	44	1.1
TNM stage (6th and 7th ed.)					<.001					<.001
I	1233	51.4	2732	60.8		1620	53.5	2527	60.9
II	843	35.2	1262	28.1		1059	34.9	1221	29.4
III	185	7.7	318	7.1		192	6.3	260	6.3
IV	45	1.9	70	1.6		50	1.7	44	1.1
Unknown	91	3.8	112	2.5		110	3.6	98	2.4
Histological subtype
SSM	1156	48.2	2679	59.6	<.001	1427	47.1	2363	56.9	<.001
NM	489	20.4	721	16.0		610	20.1	665	16.0
LMM	201	8.4	480	10.7		296	9.8	543	13.1
Other/unspecified	551	23.0	614	13.7		698	23.0	579	14.0
Tumor localization					.003					<.001
Head/ neck	710	29.6	1221	27.2		699	23.1	900	21.7
Trunk	952	39.7	1943	43.2		407	13.4	713	17.2
Upper limbs	423	17.7	838	18.7		802	26.5	1170	28.2
Lower limbs	300	12.5	480	10.7		1116	36.8	1357	32.7
Unknown	12	0.5	12	0.3		7	0.2	10	0.2
Subgroup analysis
Number of comorbidities^a					<.001					<.001
None	97	33.1	82	15.5		143	40.5	128	26.5
1	73	24.9	129	24.4		101	28.6	135	28.0
2	107	36.5	267	50.5		92	26.1	154	31.9
Unknown	16	5.5	51	9.6		17	4.8	66	13.7

^a Data only available for a subgroup of the total study population (n = 1658, 12% of total study population).

Abbreviations: IQR: interquartile range; LMM: lentigo maligna melanoma; NM: nodular melanoma; SSM: superficial spreading melanoma.

Figure 2. Annual median Breslow thickness by year, sex and age category (2003–2015).

Table 3. Relative excess rate of dying due to melanoma, by age category and sex (2003–2015).

	<70 years				≥70 years
	Men	Men	Women	Women	Men	Men	Women	Women
	Univariable	Multivariable	Univariable	Multivariable	Univariable	Multivariable	Univariable	Multivariable
	RER (95% CI)	RER (95% CI)	RER (95% CI)	RER (95% CI)	RER (95% CI)	RER (95% CI)	RER (95% CI)	RER (95% CI)
N	18,793		23,681		6891		7181
Period of diagnosis
2003–2009	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
2010–2015	0.63 (0.57–0.71)	0.75 (0.67–0.83)	0.72 (0.61–0.85)	0.77 (0.67–0.89)	0.75 (0.60–0.94)	0.97 (0.81–1.16)	0.61 (0.46–0.81)	0.95 (0.79–1.16)
Histological subtype
SSM	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
NM	5.51 (4.87–6.23)	1.08 (0.94–1.23)	5.90 (4.98–7.00)	1.09 (0.91–1.31)	4.83 (3.68–6.33)	0.79 (0.63–0.98)	7.57 (5.11–11.2)	0.95 (0.74–1.20)
LMM	0.30 (0.09–1.00)	0.48 (0.17–1.30)	0.39 (0.07–2.02)	0.36 (0.09–1.49)	0.07 (0.00–72.2)	0.53 (0.23–1.19)	0.00 (0.–)	0.50 (0.17–1.46)
Other/unspecified	2.65 (2.28–3.07)	1.00 (0.86–1.16)	2.32 (1.89–2.86)	0.89 (0.73–1.09)	3.23 (2.38–4.39)	0.91 (0.71–1.16)	4.94 (3.24–7.51)	1.00 (0.75–1.32)
Tumor localization
Head/neck	1.29 (1.10–1.51)	1.00 (0.86–1.17)	1.37 (1.08–1.74)	1.35 ( 1.08–1.70)	1.28 (0.98–1.68)	0.85 (0.68–1.06)	0.66 (0.45–0.98)	0.71 (0.53–0.95)
Trunk	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Upper limbs	0.66 (0.55–0.80)	0.73 (0.62–0.86)	0.46 (0.36–0.61)	0.65 (0.53–0.82)	0.63 (0.40–0.97)	0.69 (0.53–0.90)	0.51 (0.35–0.76)	0.62 (0.47–0.81)
Lower limbs	1.04 (0.89–1.21)	0.82 (0.71–0.95)	0.67 (0.56–0.81)	0.72 (0.61–0.85)	1.58 (1.16–2.14)	0.90 (0.70–1.16)	0.55 (0.38–0.78)	0.59 (0.45–0.75)
Unknown	1.28 (0.30–5.46)	1.78 (0.52–6.04)	0.00 (0–.)	0.00 (0–.)	1.08 (0.13–8.75)	1.81 (0.47–7.00)	0.77 (0.05–12.16)	1.48 (0.33–6.68)
Breslow thickness (log, in mm)	3.65 (3.47–3.85)	2.98 (2.80–3.18)	4.26 (3.97–4.58)	3.35 (3.07–3.67)	3.24 (2.95–3.56)	3.07 (2.74–3.44)	3.90 (3.50–4.33)	3.41 (3.01–3.86)
Lymph node status
N0	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
N+	7.98 (7.09–8.99)	2.42 (2.14–2.73)	11.4 (9.65–13.3)	2.86 (2.43–3.37)	8.00 (6.33–10.1)	2.49 (2.03–3.05)	9.76 (7.38–12.91)	2.18 (1.73–2.76)
Unknown	0.91 (0.76–1.09)	1.33 (1.14–1.56)	0.79 (0.62–1.02)	1.23 (1.00–1.53)	1.03 (0.72–1.46)	1.43  (1.13–1.82)	1.01 (0.66–1.55)	1.44 (1.12–1.84)
Distant metastases
No	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)	1.00 (ref)
Yes	36.7 (30.6–44.0)	8.32 (6.84–10.11)	60.9 (47.0–79.0)	7.21 (5.46–9.52)	17.7 (13.1–23.8)	3.76 (2.69–5.25)	29.3 (20.8–41.1)	4.01 (2.82–5.70)

Abbreviations: CI: confidence interval; LMM: lentigo maligna melanoma; NM: nodular melanoma; RER: relative excess rate of dying; SSM: superficial spreading melanoma.