Dermatology: Practical and Conceptual


Original Article | Dermatol Pract Concept. 2025;15(2):4936 1

Age-related Survival Declines in Turkish Patients 
with Cutaneous Melanoma: A Retrospective 

Analysis
Faruk Tas1, Kayhan Erturk2

1 Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey

2 Department of Medical Oncology, Prof. Dr. Cemil Tascioglu Teaching Hospital, University of Health Sciences, Istanbul, Turkey

Key words: Melanoma, Age-related survival, Older patients, Prognosis, Turkey

Citation: Tas F, Erturk K. Age-related survival declines in Turkish patients with cutaneous melanoma: a retrospective analysis.  
Dermatol Pract Concept. 2025;15(2):4936. DOI: https://doi.org/10.5826/dpc.1502a4936

Accepted: January 14, 2025; Published: April 2025

Copyright: ©2025 Gencoglu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Dr. Faruk TAS. Institute of Oncology, Istanbul University. Capa, 34390, Istanbul, Turkey. ORCID ID: 0000-0001-
6514-7116. E-mail: faruktas2002@yahoo.com

Introduction: In cancer patients, the age of a patient at the time of diagnosis is considered among the 
important clinical indicators.

Objectives: We aimed to investigate this significance in melanoma patients by creating patient age 
groups.

Methods: A total of 1,496 adult skin melanoma patients were evaluated retrospectively. Patients were 
divided into six age groups: under 30 (<30), 31–39 (30s), 40–49 (40s), 50–59 (50s), 60–69 (60s), and 
70 and older (70+).

Results: The median age was 52 years (range 16-104), and the most common age group was the 50s 
(n=340, 22.7%). As age increased, so did the Clark level (P=0.0001), the rate of ulceration (P=0.0001), and 
the rate of BRAF wild-type (P=0.002). The recurrence rates of early-stage patients were similar for all age 
groups. A significant overall survival (OS) advantage was found only between the following age groups: 
<30 and 60s (P=0.04) and <30 and 70+ (P=0.01). Five-year OS were, from young to old: 70.5%, 66%, 
63.1%, 66.3%, 57.2%, and 46.8%. A significant OS advantage was found only between the following 
age groups: <30 and 60s (P=0.04) and <30 and 70+ (P=0.01). The 70+ group had significantly worse OS 
rates in all age groups (<30: P=0.0001; 30s P=0.0001; 40s: P= 0.001; 50s: P=0.0001; and 60s: P=0.04).

Conclusion: While some unfavorable histopathological prognostic factors are associated more frequent-
ly with increasing age, clinical stage and recurrence do not differ significantly between age groups. A 
possible explanation for this might be that the elderly have more comorbidities and die of different causes.

ABSTRACT



2 Original Article | Dermatol Pract Concept. 2025;15(2):4936

Introduction

Skin melanoma is the most fatal cutaneous malignancy in 

the world and is the fifth most common type of cancer in 

men (6%) and women (4%) in the US [1]. In 2023, 97,610 

patients in the US were expected to be diagnosed with mela-

noma, and 7,990 patients were expected to die of melanoma 

[1]. Its incidence continues to dramatically increase: the life-

time risk of developing melanoma is 1 in 28 males and 1 in 

41 females. The survival of melanoma depends mainly on 

the stage at presentation of the disease [2]. In locoregional 

disease, outcome also depends on nodal involvement, tumor 

depth, and various histopathological features, such as ulcer-

ation and mitosis [2]. Apart from these important prognostic 

factors, the patient’s age at the time of the diagnosis is also 

considered among the significant clinical indicators, albeit 

not as substantial. Studies comparing young and old mela-

noma patients, with patients in various age groups, showed 

that older patients generally have worse survival rates mainly 

because they have worse prognostic factors; not surprisingly, 

younger patients live longer owing to better prognostic fac-

tors [3-9].

Objectives

However, there are also criticisms of the results found in stud-

ies on age; the most important of these are that age limits vary 

among the studies, and the number of age groups compared 

do not exceed two or three. Considering these controversies, 

we examined the clinical significance of age in Turkish mela-

noma patients by creating more age groups in this study.

Methods

Patients

The data of 1,496 adult skin melanoma patients who were 

admitted to the Oncology Institute between 1993 and 2022 

were included in the analysis and evaluated retrospectively. 

The patient-related records were retrieved from the cancer 

registry for review of the demographic, clinical, and patho-

logical characteristics and survival. In our study, the AJCC 

8th edition was used for staging the disease [2]. Lymph 

node status was determined by either sentinel lymph node 

SLN biopsy or lymph node dissection. The treatment and 

 follow-up of the patients were carried out as recommended 

by internationally accepted standard guidelines, including 

the European Society of Medical Oncology and the National 

Comprehensive Cancer Network Guidelines. The study was 

reviewed and approved by our Regional Ethics Committee. 

Patients were divided into six age groups by decades, from 

young to old: I: under 30 years old (<30), II: 31–39 years old 

(30s), III: 40–49 years old (40s), IV: 50–59 years old (50s), V: 

60–69 years old (60s), and VI: 70 years old and older (70+). 

The impacts of clinicopathological variables on age groups 

were determined using the chi-squared test. Recurrence-free 

survival (RFS) was calculated from the date of pathologic 

diagnosis to the date of the clinical recurrence, which was 

defined as detected by imaging studies or by clinical exam-

ination. Overall survival (OS) was defined as the time from 

the date of diagnosis to the date of death from any cause or 

the date of the last follow-up. Survival values and graphs 

were determined using the Kaplan-Meier method. General 

statistical analysis was performed using SPSS 21.0 software 

(SPSS Inc., Chicago, Illinois, USA).

Results

Patient Characteristics

A total of 1,496 patients with skin melanoma were included 

in the study. The median age of patients was 52 years (range 

16-104 years). The most frequent age group was the 50s 

(N=340, 22.7%), with the other groups are as follows in de-

scending order: 40s (N=300, 20.1%), 60s (N=292, 19.5%), 

30s (N= 232, 15.5%), 70+ (N=198, 13.2), and <30 (N=134, 

9%) (Figure 1). Other demographic and clinicopathological 

characteristics of the patients are shown in Table 1.

Association Between Clinicopathological 
Parameters and Age Group

The differences between age groups were found statistically 

significant in the following parameters: sex (P=0.0001), 

Clark level (P=0.0001), ulceration (P=0.0001), BRAF mu-

tation (P=0.002), neurotropism (P=0.008), and lympho-

vascular invasion (P=0.05) (Table 1). Furthermore, various 

clinicopathological variables, such as Clark level (P=0.0001), 

ulceration (P=0.003), regression (P=0.008), BRAF mutation 

(P=0.002), and association with preexisting nevus (P=0.04), 

between younger (under 30 years) and elderly (over  

70 years) patients were found statistically significant (Table 1).  

However, TNM clinical stage, which is considered to be the 

most important clinical prognostic factor, was not found sig-

nificantly different among all age groups, only in young–old 

(under 30 vs over 70) patients (P>0.05) (Table 1).

Recurrence and RFS

The recurrence rates of early-stage patients were not sig-

nificantly different among all age groups, only in old-young 

patients (P>0.05) (Table 1). The 5-year RFS values were as 

follows: from young to old: 69.7, 62.5, 56.2, 60, 56.5, and 

55.9% (Figure 2). The RFS curves according to age group 

are shown in Figure 3. A significant survival advantage was 

found only between the following age groups: the <30 and 

the 60s (P=0.04) and the <30 and the 70+ (P=0.01).



Original Article | Dermatol Pract Concept. 2025;15(2):4936 3

Figure 1. Distribution of patients by age group.

9.0

15.5

20.1

22.7

19.5

13.2

0

5

10

15

20

25

<30 30s 40s 50s 60s 70+

%

Age groups

OS

The 5-year OS values from young to old were as follows: 

70.5, 66, 63.1, 66.3, 57.2, and 46.8% (Figure 4). The OS 

curves according to age group are shown in Figure 5. A 

significant survival advantage was found only between 

following age groups: <30 and 60s (P=0.04) and <30 and 

70+ (P=0.01). The 70+ patient group had significantly 

worse survival rates compared to all age groups (with <30: 

P=0.0001; with 30s: P=0.0001; with 40s: P= 0.001; with 

50s: P=0.0001; and with 60s: P=0.04). Apart from these, a 

significant difference in survival was shown only between 

<30 and 60s in other age groups.

Conclusions

In our retrospective study, 1,496 melanoma patients were 

generally clustered in or around the 50s age group; the 

median age of patients was 52 years (range 16-104 years). 

There was a significant increase in the Clark level and the 

presence of ulceration with aging. Moreover, we found that 

the BRAF mutation rate was the highest in young people 

and that it decreased with age, dropping to the lowest rate 

in elderly patients. On the other hand, clinical stage distri-

bution and recurrence rates were not significantly different 

between all age groups. Regarding relapse-free survival, pa-

tients younger than 30 years had better survival than those 

˃60 years, especially those ˃70 years. Also, younger patients 

had significantly better survival than those over age 60 years, 

and patients over age 70 years showed significantly worse 

overall survival than younger patients from all age groups. 

Both the incidence of melanoma and the median age of the 

patients have continued to increase significantly in the USA 

over the years [3]. In the SEER data, the median age of mel-

anoma at diagnosis was 51 years for 1974–1978 and 65 for 

2014–2018. However, no difference was found in the median 

age of Turkish skin melanoma patients between 1988 and 

2017. In a novel study, we found that the median age of the 

patients between 2011 and 2020 was 53 years, which was 

12 years younger than the US patients according to SEER 

data from 2014 to 2018 [3]. In many melanoma studies, 

patient age at diagnosis has been shown to be a significant 

prognostic factor for the outcome. Older age was correlated 

with lower melanoma survival because primary melanomas 

in older patients have more unfavorable clinicopathological 

characteristics; they are thicker, more ulcerated, and have 

greater mitotic rates [3-6]. In an earlier study, we grouped 

1,169 melanoma patients as young (<40 years), middle-aged 

(40-59 years), and old (≥60 years) [7]. We found that al-

though patient age did not have a significant predictive role 

in terms of nodal involvement, recurrence, or metastasis, an 

age of ≥60 years may be associated with more aggressive 

histological features (non-superficial spreading histology, 

higher Clark level, and ulceration) and poorer outcomes. 

The older patients had poorer survival compared with the 

other ages (P=0.009 for young patients and P=0.012 for 

middle-aged patients). While a significant correlation was 

found for overall survival, patient age was not significantly 

associated with relapse-free survival (P=0.327). Similarly, 

a large analysis (N=17,600) demonstrated that older mel-

anoma patients had more advanced primary tumors and 

lower melanoma survival [4]. In another large multinational 

study, although melanoma patients had a lower rate of node 

positivity, patients over age 70 years had melanomas with 

the most aggressive prognostic features, such as head and 

neck localizations, thicker and more ulcerated melanomas, 

and greater mitotic rates [5]. Likewise, a single institutional 

study on 225 stage 3 melanomas showed that older patients 

had higher tumor stages, higher Breslow depths, higher rates 



4 Original Article | Dermatol Pract Concept. 2025;15(2):4936

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6 Original Article | Dermatol Pract Concept. 2025;15(2):4936

depth, low mitotic rate, and absence of ulceration [7]. The 

majority of young patients harbored BRAF V600E mutation 

(59.1%). Even though age is not considered a significant 

indicator of nodal involvement, recurrence, and/or metas-

tasis, being under age 40 may be associated with favorable 

histopathological features and better survival compared to 

more advanced ages, especially beyond age 60. A national 

cohort study from the Netherlands showed that advanced 

melanoma patients between ages 15 and 39 (N=210) were 

more frequently female (51 vs 40%, P=0.001) harboring 

BRAF mutation (68 vs 46%, P<0.001), non-nodular histo-

pathology (88 vs 78%, P=0.003), and thin Breslow thick-

ness (≤2 mm) (43 vs 32%, P<0.0001) compared with older 

melanomas [9]. There was an overall survival advantage for 

young melanomas over older patients, with a 1-year sur-

vival of 64.7 vs 55% (P<0.001). This longer overall sur-

vival observed in these young patients was explained by the 

increased cumulative incidence of non-melanoma-related 

deaths in older adults. In another study, we investigated 146 

melanomas in their 20s and compared them with 1,139 older 

melanomas [8]. The majority of the lesions were associated 

with favorable prognostic indicators such as non-nodular 

histotype (68%), lower mitotic rate (58.1%), low lympho-

vascular invasion (87.5%), BRAF mutation (70.6%), node 

negativity (70.1%), and nonmetastatic disease (91.8%). The 

5-year disease-free and overall survival rates for vicenarians 

versus adult melanomas were similar compared with older 

melanomas.

Some unfavorable prognostic factors, such as high Clark 

levels, presence of ulceration, and fewer BRAF mutations, are 

encountered more frequently with increasing age; however, 

Figure 2. Five-year recurrence-free survival (RFS) values per age 

group.

69.7

62.5

56.2

60.0

56.5 55.9

40

45

50

55

60

65

70

75

<30 30s 40s 50s 60s 70+

%

Age groups

5-year RFS

Figure 3. Recurrence-free survival curves in melanoma Patients ac-

cording to age group ( <30 vs 30s, P=0.2; <30 vs 40s, P=0.08; <30 

vs 50s, P=0.1; <30 vs 60s, P=0.04; <30 vs 70+, P=0.01, 30s vs 40s, 

P=0.4; 30s vs 50s, P=0.6; 30s vs 60s, P=0.2; 30s vs 70+, P=0.1; 40s 

vs 50s, P=0.8; 40s vs 60s, P=0.7; 40s vs 70+, P=0.4; 50s vs 60s, 

P=0.5; 50s vs 70+, P=0.2, and 60s vs 70+, P=0.7).

0.0

0.2

0.4

0.6

0.8

1.0

R
ec

ur
re

nc
e 

Fr
ee

 S
ur

vi
va

l

of tumor ulceration, and poorer outcomes than did younger 

patients [6]. Melanoma accounts for 10–11% of all malig-

nancies in adolescent and young adult patients between ages 

15 and 39 [8]. This type of melanoma differs from adult 

melanoma in histopathological characteristics and clinical 

courses. In our previous study, we observed that melanomas 

under age 40 (N=297) were found mostly in females and 

that they were associated with low Clark level, thin Breslow 

Figure 4. Five-year overall survival (OS) values per age group.

70.7

66.0
63.1

66.3

57.2

46.8

40

45

50

55

60

65

70

75

80

<30 30s 40s 50s 60s 70+

%

Age group

5-year OS



Original Article | Dermatol Pract Concept. 2025;15(2):4936 7

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Figure 5. Overall survival curves in melanoma patients according to 

age group (<30 vs 30s, P=0.4; <30 vs 40s, P=0.1; <30 vs 50s, P=0.2; 

<30 vs 60s, P=0.04; <30 vs 70+, P=0.0001, 30s vs 40s, P=0.4; 30s 

vs 50s, P=0.7; 30s vs 60s, P=0.09; 30s vs 70+, P=0.0001; 40s vs 50s, 

P=0.7; 40s vs 60s, P=0.2; 40s vs 70+, P=0.001; 50s vs 60s, P=0.09; 

50s vs 70+, P=0.0001, and 60s vs 70+, P=0.04).

0.0

0.2

0.4

0.6

0.8

1.0
O

ve
ra

ll 
Su

rv
iv

al

other significant clinical prognostic factors, such as clinical 

stage and recurrence, do not differ between age groups. The 

possible explanation for shorter overall survival and partly 

shortened disease-free survival of older melanoma patients 

may be that since the elderly have more comorbidities, they 

may die of different causes. The heterogeneity of primary 

melanomas and the differences in outcomes between young 

and elderly melanoma patients have yet to be defined in 

more prospective studies with greater patient numbers and 

more detailed age groups.