Diverging melanoma mortality trends in Brazil: declining age-standardized rates despite persistent sex and regional inequalities, 2015–2024

BACKGROUND: Melanoma mortality varies markedly across populations, and demographic ageing may obscure changes in underlying risk. OBJECTIVE: To examine melanoma mortality trends in Brazil from 2015 to 2024, emphasizing age-standardized rates and sex and regional inequalities. METHODS: We conducted an ecological time-series study using national mortality data for cutaneous malignant melanoma and official population estimates. Crude, age-specific, and age-standardized mortality rates were calculated. National and regional rates were standardized by the direct method using the World Health Organization World Standard Population. Temporal trends were assessed with log-linear and segmented log-linear regression. Sex differences were examined using Poisson regression with population offsets and a sex-by-year interaction term. RESULTS: A total of 18,963 deaths were recorded. Mortality was concentrated in older age groups and was higher in males (overall rate ratio=1.41; 95% confidence interval: 1.37-1.46), with no evidence that the male excess changed over time (interaction p = 0.995). The age-standardized mortality rate declined from 0.84 per 100,000 inhabitants in 2015 to 0.74 in 2024, corresponding to an annual percent change of -1.29% (95% confidence interval: -2.07 to -0.49). No significant change in slope was detected (p = 0.890), whereas crude mortality increased slightly. Regional inequalities persisted after age standardization. In 2024, standardized rates were 1.46 per 100,000 in the South and 0.41 in the North, yielding a South-to-North ratio of 3.55, compared with 5.49 for crude rates. CONCLUSIONS: Melanoma mortality declined after adjustment for age, while crude mortality increased slightly, indicating an important contribution of population ageing. Persistent male excess and regional inequalities support targeted prevention, early detection, and equitable access to specialized care.