Trends and disparities in melanoma mortality among older adults: A SEER analysis, 2000–2023.

253 Background: Melanoma is a rare cancer accounting for approximately 1% of all skin cancers with a higher incidence in older adults with a median age of diagnosis of 66 years. We studied national mortality trends and demographic disparities in older adults with melanoma. Methods: A retrospective analysis of mortality trends among melanoma patients aged 65 years and above, diagnosed between 2000 and 2023, was conducted using the Surveillance, Epidemiology, and End Results Program (SEER) database. Variables including age, gender, race, and age-adjusted mortality rates (AAMR) were extracted and analyzed. Annual percent changes (APCs) in AAMRs with 95% confidence intervals were calculated using Joinpoint regression analysis across demographic subgroups (sex and race/ethnicity). Results: Between 2000 and 2023, 229,445 documented deaths in the US were attributed to melanoma. The overall AAMR demonstrated: initial increase from 11.6 per 100,000 in 2000 to 13.8 in 2013 (APC: 1.5%; 95% CI: 1.2% to 1.7%), followed by significant decline to 11.3 in 2017 (APC: -5.2%; 95% CI: -6.7% to -3.6%), with continued but slower decrease to 10.8 in 2023 (APC: -0.8%; 95% CI: -1.4% to -0.3%). Significant gender disparities persisted throughout the study period, with males maintaining consistently higher AAMRs than females (19.6 vs. 7.3 per 100,000). Male mortality increased from 18.0 in 2000 to peak at 22.3 in 2013, then declined substantially to 16.9 in 2023. Female mortality showed modest increase from 7.5 in 2000 to 7.7 in 2014, followed by decline to 6.2 in 2023. Pronounced racial and ethnic disparities were observed. Non-Hispanic White patients had the highest AAMR (14.6 per 100,000), followed by Hispanic or Latino patients (3.7), non-Hispanic Black or African American patients (2.1), with non-Hispanic Asian or Pacific Islander patients having the lowest rates (1.7). Conclusions: Despite overall improvements in melanoma mortality among older adults over the past two decades, significant disparities persist. Mortality remains markedly higher in men compared to women, and among non-Hispanic White patients relative to other racial and ethnic groups. The sharp decline in mortality after 2013 likely reflects the impact of advances in melanoma treatment, including immunotherapy and targeted therapies. Further studies are needed to better understand the drivers of these disparities and guide efforts to improve outcomes across all populations.