The number of melanoma cases in the elderly (>65 years) will rise over the coming decades, making it an important public health problem. Elderly white men are the demographic group who are at highest risk of being diagnosed with melanoma and of dying from this cancer. Among patients with melanoma, older age is recognized as an independent poor prognostic factor, but it remains unclear whether this relationship is due to a change in the biology of the disease with increasing patient age, declining host defenses, or both. Most elderly patients can have surgery to control locoregional disease, but might not be candidates for intensive biologic therapies for advanced melanoma because of comorbidities and inability to tolerate the adverse side effects of these treatments. Early detection remains an important strategy for the management of melanoma. Further research is needed to determine why older melanoma patients have a worse prognosis than their younger counterparts, even when matched for all other clinical and pathological predictors of survival outcomes.