Cutaneous Melanoma in Older Adults with Frailty

Frailty syndrome predominantly affects older adults. Older age is associated with a higher incidence of melanoma and a high disease-related mortality. The combination of an ageing population and a rising incidence of melanoma is leading to the increasing prevalence of melanoma in older adults with frailty, which poses a significant challenge to treating teams. The introduction of BRAF targeted therapy and immune checkpoint inhibitors has drastically changed the management and prognosis for patients with melanoma. However, this subgroup of patients are less likely to be recruited into clinical trials and those who are recruited are unlikely to be representative of their age group in the general population due to a selection bias towards a healthier and more active individual. The current evidence for management decisions in these patients is based on data extrapolation from age subgroup analyses from clinical trials, retrospective reviews of real-world data and clinician experience. The suitability of these treatments and the balance of risk and benefit require careful consideration for older patients with frailty. This chapter reviews the most suitable treatment options for this subgroup of patients diagnosed with cutaneous melanoma, from an early stage to a metastatic setting.