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A study by Associate Professor Onur Baser and colleagues found that immunotherapy, especially PD-1/PD-L1–based regimens, has become the dominant treatment approach for older U.S. patients with mucosal melanoma, while surgery remains the main potentially curative option. The analysis also showed that treatment intensity varies by tumor site and stage, with combination immunotherapy used more often in patients with more advanced or anatomically complex disease.
For the study, the research team used Surveillance, Epidemiology, and End Results (SEER)-Medicare–linked data from 2014 to 2021 and identified 1,362 patients age 65 and older with mucosal melanoma, a rare and aggressive cancer that arises in mucosal tissues rather than the skin. The median age was 76, 57.6% were female, and the most common primary sites were vulvovaginal, rectal/anal, and nasal cavity. Overall, 41.3% of patients underwent surgery, and among those patients, 36.2% received systemic therapy within 90 days, which the authors treated as adjuvant therapy.
Among patients who did not have surgery, 63.3% received systemic therapy as first-line treatment, and PD-1/PD-L1 regimens made up 66.6% of those treatments. In the surgical group, PD-1/PD-L1–based regimens accounted for 51.5% of adjuvant systemic therapy, with monotherapy used more often than combination treatment. The study also found that chemotherapy and targeted therapies were used less frequently overall, though KIT inhibitors remained the main targeted option when those drugs were used.
Treatment patterns were not uniform across mucosal melanoma subtypes. Rectal/anal and nasal cavity tumors were more likely to receive surgery and systemic treatment than some other sites, while distant-stage disease was far less likely to be treated surgically and more likely to receive first-line systemic therapy. Combination immunotherapy was more common in patients who did not undergo surgery and in higher-risk settings, suggesting clinicians may intensify treatment when disease is harder to remove or more advanced.
“We’re seeing treatment move away from older approaches and toward immunotherapy, which is now the mainstay for many patients with mucosal melanoma,” says Dr. Baser. “At the same time, some patients still receive chemotherapy, and targeted therapy may be an option for a small number of people whose tumors have specific mutations. Because this cancer is so rare and behaves differently from other melanomas, we still need more studies to figure out the best treatment for each patient.”
