Among older patients, melanoma in general presents biological features related to a more aggressive biology, such as more locally advanced tumor. Management of melanoma in elderly may be difficult, mainly due to comorbidities. We report the experience of the Melanoma Unit of ASST Spedali Civili in Brescia, Italy.Study subjects were drawn from 3444 patients with histological confirmed melanoma. Data were extracted from electronic database of the Melanoma Unit of ASST Spedali Civili in Brescia, Italy. Patients who received diagnosis of cutaneous melanoma at age of 65 years or older were retrospectively evaluated. For each diagnosed melanoma, histological characteristics, treatment, and outcomes were evaluated.Of the 805 patients described in this study, 444 were males and 361 females. Statistically significant differences were found between patients aged 65-80 years and those aged >80 years considering melanoma prognostic factors, such as Breslow thickness, number of mitoses/mm2 and ulceration.Older age is recognized as an independent poor prognostic factor in melanoma patients, and melanoma in older patients have a distinct natural history. It was found that management of cancer in old person represents a major challenge to medical practice. We believe that the choice of therapy should be individualized and based upon the individual's overall health and that, particularly in these cases, management often requires interdisciplinary cooperation between dermatologist, surgical specialist, oncologist and geriatrician.