Metastatic melanoma in the older patient: special considerations

Cancer is a disease of older age where genomic instability, impaired DNA repair, and weakened immune surveillance against cancer are recognized to play a causative role. Because the incidence of melanoma is increasing at a very fast pace in the elderly and there is a rapid expansion of the aging population, a large number of elderly patients with metastatic melanoma will be encountered in clinical practice. As a result, significant burden is expected to be placed on health care resources as effective treatment of this condition is sought. Because melanoma is an immunogenic tumor and promising immune-based treatments have acquired approval for treatment of metastatic melanoma, their successful use in elderly patients will require knowledge about aging and associated alterations in immune function. The spotlight will likely remain on antitumor immunity, its regulation and quality, and the profiles of the cytokines that shape the tumor microenvironment.