Primary Cutaneous Melanoma Among Transgender Individuals in a Health Maintenance Organization: A Case Series

Transgender and Gender Diverse (TGD) individuals face unique healthcare challenges, including increased cancer burden, systemic barriers to care and limited reported data in scientific literature. In dermatology and particularly in dermato-oncology, TGD populations remain notably underrepresented. This case series aims to contribute to the limited body of literature by describing melanoma incidence and treatment patterns among TGD individuals within a large, integrated health system. We conducted a retrospective review of the Kaiser Permanente Northern California Regional Cancer Registry to identify TGD patients diagnosed with cutaneous melanoma between January 1, 2018 and December 31, 2022. Medical records were reviewed for demographic data, gender identity, Gender-Affirming Hormone Therapy (GAHT) use, melanoma features and treatment timelines. Among 6,456 identified TGD individuals, only six (four transfeminine, two transmasculine) were diagnosed with a total of eight melanomas (four in situ, four pT1a). All were Stage Ia or lower, with no evidence of regional or distant spread. Five patients had a history of GAHT, with an average estradiol duration of 13.75 years. Notably, a transfeminine patient on long-term estradiol and progesterone developed three melanomas over four years. Time to surgical excision ranged from 11 to 49 days (mean 24), aligning with institutional averages for cisgender patients. This study offers an early contribution to understanding melanoma in TGD populations and highlights the importance of documenting care patterns in a group with historically limited representation. Our findings suggest that, within an insured and integrated care system, TGD patients may receive timely, guideline-concordant melanoma treatment. Still, further work is urgently needed to evaluate risk factors, explore the role of GAHT and amplify TGD voices to inform inclusive dermatologic oncology care.