Melanoma Epidemiology, Diagnosis, and Overdiagnosis in the SEER Database

Conclusions

• Melanoma diagnoses have increased over time, but mortality has remained relatively stable, supporting concern that some of the rise reflects overdiagnosis rather than a true increase in lethal disease.
• Most melanoma cases are diagnosed in older adults, with men tending to present later in life than women.
• Younger women under 40 appear to have a disproportionately high burden of thin melanomas compared with men, suggesting a major source of increased detection in low-thickness disease.
• Thin T1 melanomas make up the largest share of diagnosed tumors, while thicker T3 and T4 lesions are much less common.
• Racial and ethnic groups show different presentation patterns, with Black and some Asian or Pacific Islander patients more likely to present with thicker or acral/nodular melanomas.
• The trunk is the most common primary site overall, but men are diagnosed more often on the trunk and head/neck, while women are more often diagnosed on the lower limbs.
• Superficial spreading melanoma remains the most common histologic subtype overall, whereas acral melanoma is relatively uncommon in the general population but more prominent in Black patients.
• During the COVID era, fewer thin melanomas were diagnosed, yet short-term survival did not appear to change, suggesting delayed detection of low-risk lesions had limited immediate impact on survival.
• Melanoma survival remains very high and has been stable or slightly improved over time, even as incidence has risen.
• Melanoma survivors have an elevated risk of second primary cancers, especially another melanoma and certain other malignancies such as eye/orbit melanoma, sarcoma, thyroid, and salivary gland cancers.