Clinical Characteristics and Outcomes of Melanoma Among Latin American Adolescents and Young Adults Compared to Middle-Aged and Elderly Population: A Cohort Analysis Over 10 Years

Vollständiger Abstract

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Introduction: Outcomes among the Hispanic population are rarely explored in adolescents and young adults (AYAs). We aimed to compare sociodemographic, clinical, and survival outcomes of Latin American AYAs (≤39 years) with middle-aged (40–59 years) and older (≥60 years) patients with melanoma. Methods: A single-center retrospective cohort study among patients with melanoma stages I–IV was conducted in Lima, Peru, from 2010 to 2019. We evaluated overall survival (OS), event-free survival (EFS) rates, and prognostic factors. Results: Of 1121 patients with melanoma, 118 (10.5%) were AYAs, 357 (31.9%) were middle-aged, and 645 (57.6%) were elderly. Less frequencies of lower extremity as primary site (56.8%, 68.9%, and 82.3%, p < 0.01), ulceration (46.8%, 58.8%, 72.5%, p < 0.01), and acral histology (22.6%, and 32.8%, and 44.3%, p < 0.01) were present in AYAs. Moreover, AYAs had a higher frequency of American Joint Committee on Cancer stages I (16.1%, 10.1%, and 7.9%) and IV (25.4%, 24.6%, and 21.9%, p < 0.01). AYAs had less frequent adjuvant chemotherapy (10.3%, 18.4%, and 11.2%, p = 0.03). With a median follow-up of 9.8 years, the 5-year OS and EFS rates for AYAs (52%, 32%) were better than the middle-aged (43%, 23%) and older population (32%, 15%) ( p < 0.01). Multivariate analyses showed that AYAs had better prognosis than elderly population (≥60 years, hazard ratio = 1.93). Conclusions: Latin American AYAs with melanoma had less aggressive tumor characteristics and received less systemic therapy compared to middle-aged patients, yet demonstrated better EFS and OS rates across all age groups. Therefore, younger age is not a risk factor for worse survival outcomes. Given the relatively high frequency of stage IV disease in AYAs, it is crucial to develop strategies for early detection in the primary care setting.