Melanoma mortality in Brazil: Insights from over 25 years of data and the impact of limited immunotherapy access in the public health system.

e22582 Background: Skin cancer is the most common cancer globally and in Brazil – and melanoma, its deadliest form. Despite advancements in Immunotherapy (IO) and Target-therapy (TT), these are mostly unavailable in Brazil’s Public Health System (PHS). Methods: Ecological study using secondary data (1996-2023) from Brazil’s PHS. Mortality rates were standardized by WHO’s population and calculated per 100,000 inhabitants. Linear regression analyzed mortality trends by region, using 2011 as a cutoff (IO and TT year of approval). Results: Between 1996-2023, 39,606 deaths occurred due to melanoma in Brazil – mostly in males (57.3%). Deaths were higher among elderly patients (16.2% males; 22.6% females), with the Southeast leading (46.6%). Mortality decreased in males ≤54 years and increased in ≥70 years (p<0.01), with similar trends found for females. Only the Southeast showed declining mortality (β -0.013; r² 0.60; p<0.001); other regions increased (p<0.001). After 2012, both genders showed downward trends. Conclusions: Despite advances, mortality rates due to melanoma increased until 2012 but declined thereafter, underscoring the possible impact of IO/TT and highlighting the need for expanded its access, especially for men and elderly citizens. Variable APC (1996-2023) MalesStandardized mortality rates by age β 95% CI Adjusted r² p* 25-29 -.022 -.040 -.004 .161 .020 30-34 -.041 -.061 -.022 .401 < .001 35-39 -.057 -.087 -.028 .355 < .001 40-44 -.108 -.138 -.077 .658 < .001 45-69 p > 0.05 70 -74 .106 .034 .178 .230 .006 75-79 .134 .069 .199 .385 < .001 ≥80 .596 .470 .723 .775 < .001 Variable APC (1996-2023) FemalesStandardized mortality rates by age β 95% CI Adjusted r² p* 20-24 -.011 -.019 -.003 .203 .009 25-29 -.015 -.028 -.002 .138 .029 30-34 -.030 -.045 -.014 .356 <.001 35-39 -.051 -.078 -.024 .347 .001 40-44 -.065 -.096 -.034 .225 <.001 45-49 -.048 -.082 -.015 .029 .006