Melanoma burden in the US, 1999-2023: Rising incidence, declining mortality, and regional inequities.

e21601 Background: Melanoma remains a significant public health concern in the United States, with rising incidence rates and variable mortality outcomes across regions. Understanding temporal trends in age-adjusted incidence and mortality, as well as geographic disparities, is critical for informing prevention strategies and optimizing healthcare resource allocation. This study evaluates trends in melanoma burden from 1999 to 2023, and examines state-level variations in mortality rates. Methods: We analyzed mortality and incidence data from the Centers for Disease Control and Prevention Wide-Ranging On-line Data for Epidemiologic Research (CDC WONDER) and United States Cancer Statistics (USCS). Data on melanoma incidence and mortality were analyzed using age-adjusted rates per 100,000 person-years. National trends were assessed for incidence (1999–2021) and mortality (1999–2023), while state-level cumulative age-adjusted mortality rates (2021–2023). We also analyzed mortality rates by site of melanoma. Results: Age-adjusted melanoma incidence rose steadily from 1999 to 2019 (peak: 23.66 per 100,000), declined during the pandemic in 2020 (20.60), and rebounded to 22.96 in 2021. Age-adjusted mortality rates (AAMR) declined significantly, from 2.64 in 1999 to 1.97 in 2023, with the steepest annual percent change (APC: -6.60, p < 0.001) observed between 2013–2017. Site-specific analysis (2021–2023) revealed the highest AAMR for head and neck melanoma (0.086), followed by trunk (0.058), lower limb (0.048), and upper limb (0.038). State-level disparities were pronounced: Utah (2.73) and Idaho (2.71) had the highest AAMR) while Hawaii (1.38) and the District of Columbia (1.34) had the lowest. Regionally, the Midwest reported the highest AAMR (2.17), followed by the West (2.00), South (1.98), and Northeast (1.75). Conclusions: Despite national declines in melanoma mortality, significant geographic and anatomic site disparities persist. The steady increase in incidence underscores the need for sustained public health efforts to promote sun safety and early detection, particularly for high-risk sites like the head and neck. Regional inequities, with elevated mortality in the Midwest and Western states, suggest gaps in healthcare access or preventive measures. Targeted interventions in high-burden regions and improved surveillance for anatomic site-specific risks are critical to reducing the melanoma burden. Further research should explore drivers of geographic and site-based disparities to inform equitable policy and clinical practice.