Cutaneous malignant melanoma in the older patient

Malignant melanoma can be a devastating disease, especially in the elderly patient. These patients may be affected by types of malignant melanoma that are seen less frequently in younger patients, namely lentigo maligna melanoma and acral lentiginous melanoma. In patients with stage I disease, age per se does not correlate directly with prognosis. However, tumor thickness does correlate directly with prognosis, and because elderly patients tend to present with thicker lesions, they have prognostically poorer outcomes. Currently one can only speculate as to why the elderly have on average thicker lesions. Surgical excision continues to be the treatment of choice for malignant melanoma. Many elderly patients are not able to tolerate more invasive procedures, such as lymph-node dissections. At this point, the physician should work with the patient and the patient's family to assess the need of each and to develop a clear medical plan. One should maintain an optimistic attitude in dealing with malignant melanoma in elderly patients. Although much work remains to be done with regard to developing new, effective therapies, even today the majority of elderly patients with malignant melanoma will not die from their disease.