United States Statistics 2025

Projected New Cases and Deaths

The American Cancer Society's Cancer Facts & Figures 2025 projects 104,960 new invasive melanoma cases in the United States for 2025, distributed as:[8]

• Males: 60,550 cases (57.7%)
• Females: 44,410 cases (42.3%)

When including melanoma in situ (non-invasive, Stage 0 disease confined to the epidermis), total melanoma diagnoses reach 212,200 cases in 2025—with approximately 107,240 in situ cases projected.

Mortality projections estimate 8,430 melanoma deaths in 2025:

• Males: 5,470 deaths (65%)
• Females: 2,960 deaths (35%)

These figures translate to approximately 287 new melanoma diagnoses daily, or roughly 12 new cases every hour. The mortality rate works out to 23 deaths per day, or one melanoma death every 65 minutes in the United States.

Incidence and Mortality Rates

The age-adjusted incidence rate stands at 21.9 per 100,000 population, while the mortality rate registers 2.0 per 100,000 population.[9] These rates vary substantially by demographic factors including age, sex, race, ethnicity, and geographic location within the United States.

Significant Recent Increases

The 104,960 invasive cases projected for 2025 represent notable increases from recent years:

• 4.3% increase from 2024 (100,640 cases)
• 7.5% increase from 2023 (97,610 cases)
• 5.2% increase from 2022 (99,780 cases)
• 42% increase from 2015 (73,870 cases)

Long-term trend analysis reveals an average annual incidence increase of 1.2% per year from 2013-2022, though this masks important variations by age and sex that will be explored in the demographics section.[10]

Declining Mortality Despite Rising Incidence

Despite steadily increasing incidence, melanoma mortality rates have been falling an average of 2.8% per year from 2014-2023.[11] This divergence—more cases diagnosed but fewer deaths—represents one of oncology's major success stories, attributable to:

1. Earlier detection through increased awareness and screening
2. Revolutionary immunotherapy treatments approved since 2011
3. Targeted molecular therapies for BRAF-mutant melanomas
4. Improved surgical techniques and adjuvant therapy protocols

The mortality decline is particularly pronounced in younger populations, with death rates falling approximately 5% annually in adults under age 50 compared to 3% annually in those aged 50 and older.[12]

Lifetime Risk

Approximately 1 in 45 Americans (2.2%) will develop melanoma during their lifetime based on current incidence patterns.[13] However, this risk varies dramatically by race and ethnicity:

• Non-Hispanic White individuals: 3% lifetime risk (1 in 33)
• Hispanic individuals: 0.5% lifetime risk (1 in 200)
• Black/African American individuals: 0.1% lifetime risk (1 in 1,000)

Among White populations specifically, lifetime risk shows gender differences:

• White males: 1 in 38 (2.6%)
• White females: 1 in 50 (2.0%)

Canadian Melanoma Data

National Incidence and Mortality (2024 Projections)

The Canadian Cancer Society's most recent projections for 2024 estimate 11,300 new melanoma cases nationally, representing one of the largest year-over-year increases in recent Canadian cancer surveillance history—a 17% jump from 2023.[14] Case distribution by sex:

• Males: 6,500 cases (57.5%)
• Females: 4,800 cases (42.5%)

Projected deaths total 1,300 in 2024:

• Males: 850 deaths (65.4%)
• Females: 440 deaths (34.6%)

These statistics reveal that while men comprise 57.5% of melanoma cases, they represent 65.4% of deaths—a pattern reflecting both biological factors and potentially delayed diagnosis in male populations.

Incidence Rates and Cancer Burden

The national age-standardized incidence rate in Canada stands at 14.12 per 100,000 population, with a crude rate of 20.75 per 100,000.[15] Melanoma represents:

• 3.8% of all male cancers in Canada
• 3.3% of all female cancers in Canada
• 1.9% of male cancer deaths
• 1.2% of female cancer deaths

Canadian Lifetime Risk

According to Public Health Agency of Canada data updated for 2025, lifetime melanoma risk in Canada shows:[16]

Men:

• 1 in 42 will develop melanoma during their lifetime
• 1 in 219 will die from melanoma

Women:

• 1 in 56 will develop melanoma during their lifetime
• 1 in 402 will die from melanoma

Canadian men face approximately 33% higher lifetime risk of developing melanoma compared to women, and are 1.8 times more likely to die from the disease—a gender disparity that warrants targeted public health interventions.

Exceptional Survival Outcomes

Canada achieves among the highest melanoma survival rates of any cancer type, with 5-year net survival of 89% overall:[17]

• Women: 91% five-year survival
• Men: 84% five-year survival
• Ten-year survival: 87% overall

The 7 percentage point survival advantage for women persists even after controlling for stage at diagnosis, suggesting both biological and behavioral factors in outcomes.

Provincial Variations

While comprehensive 2025 provincial data remains limited, historical analysis from 2011-2017 identified significant geographic variations:[18]

Highest provincial incidence rates:

• Prince Edward Island: 33.86 per 100,000 (exceeds U.S. national average)
• Nova Scotia: 30.77 per 100,000
• New Brunswick: 22.55 per 100,000
• Ontario: 22.47 per 100,000
• British Columbia: 20.89 per 100,000

The Maritime provinces show dramatically elevated rates even after age adjustment, suggesting unique environmental, genetic, or behavioral risk factors in these regions. British Columbia's 17% increase from 2023 to 2024 represents particularly concerning growth requiring investigation.

Healthcare Access Challenges

Canada faces severe dermatology workforce shortages that threaten optimal melanoma care. Only approximately 800 certified dermatologists serve 40 million Canadians, yielding roughly 2 dermatologists per 100,000 population—well below the United States rate of 3.5 per 100,000.[19]

Distribution is highly uneven: 507 dermatologists practice in urban areas while only 3 serve rural regions. Without changes in training capacity, this ratio is projected to decline to 1.1 dermatologists per 100,000 by 2030, exacerbating existing wait times that can extend months for non-urgent consultations.[20]

Demographic Patterns and Risk Groups

Age Distribution

Melanoma predominantly affects older adults, though it remains one of the most common cancers in younger populations. U.S. age distribution shows:[21]

Median age at diagnosis: 66 years (previously reported as 59 years in some datasets)

Age group distribution:

• Under 20 years: 0.3% of cases
• Ages 20-34: 4.1% of cases
• Ages 35-44: 8.3% of cases
• Ages 45-54: 13.4% of cases
• Ages 55-64: 21.5% of cases
• Ages 65-74: 27.4% of cases (peak incidence)
• Ages 75-84: 19.7% of cases
• Ages 85+: 5.3% of cases

Individuals aged 55 and older represent 77% of all melanoma cases, reflecting the disease's nature as one of cumulative UV exposure. However, melanoma ranks as the 3rd most common cancer in young adults aged 20-39, highlighting its relevance across the age spectrum.[22]

Median age at death: 73 years

Death concentration by age:

• Ages 65-84: 52.6% of all melanoma deaths
• The highest mortality occurs roughly 7 years later than peak incidence, reflecting both disease biology and treatment duration

Gender Patterns: A Complex Story

One of melanoma epidemiology's most striking recent findings involves shifting gender patterns by age group.

Revolutionary Finding: Young Women Now at Higher Risk

Women under age 50 now have dramatically higher melanoma incidence than men:[23]

• Women under 50: 141.1 per 100,000
• Men under 50: 77.4 per 100,000
• 82% higher incidence in young women

This represents a complete reversal from historical patterns and appears driven by multiple factors including indoor tanning bed use (particularly prevalent among young women), different sun exposure behaviors, and possibly hormonal influences.

Age 50 as the Crossover Point

Ages 50-64: Near parity

• Women: 832.5 per 100,000
• Men: 830.6 per 100,000

After age 65: Male predominance emerges strongly

• By age 65: men's rates double women's rates
• By age 80: men's rates triple women's rates

Long-term Trend: Gender Gap Narrowing

The male-to-female incidence ratio has narrowed substantially over recent decades:

• 1992: 1.6:1 (male to female)
• 2021: 1.1:1 (male to female)

This convergence reflects both increasing rates in women (particularly younger women) and some stabilization in younger men.

Mortality Gender Gap

Despite only modestly higher overall incidence, men experience disproportionate mortality:

U.S. 2025 mortality:

• Males: 5,470 deaths from 60,550 cases (9.0% case fatality)
• Females: 2,960 deaths from 44,410 cases (6.7% case fatality)

Canada 2024 mortality:

• Males: 850 deaths from 6,500 cases (13.1% case fatality)
• Females: 440 deaths from 4,800 cases (9.2% case fatality)

Men are 85% more likely to die from melanoma in the U.S. and 43% more likely in Canada, even controlling for incidence differences.

Anatomic Site Differences

Gender differences in melanoma location partly explain outcome disparities:[24]

Men most commonly develop melanoma on:

• Trunk (torso): 40-45% of cases
• Head and neck: 25-30% of cases
• Upper extremities: 15-20% of cases

Women most commonly develop melanoma on:

• Lower extremities (legs): 35-40% of cases
• Trunk: 25-30% of cases
• Upper extremities: 20-25% of cases

Trunk and head/neck melanomas carry worse prognosis than extremity melanomas due to differences in detection timing, lymphatic drainage patterns, and biological behavior. This anatomic distribution contributes to male mortality disadvantage.

Racial and Ethnic Disparities

Melanoma incidence varies profoundly by race and ethnicity, yet outcome disparities are even more dramatic.[25]

Incidence Rates by Race/Ethnicity

Non-Hispanic White: 24.6-34.7 per 100,000 (highest)

• Rates increase with proximity to equator and UV index
• Fair skin (Fitzpatrick types I-II) at greatest risk

Hispanic/Latino: 4.2-5.0 per 100,000

• Approximately 7-fold lower than non-Hispanic Whites
• Higher proportion of acral melanomas

Asian/Pacific Islander: 1.3 per 100,000

• Approximately 30-fold lower than non-Hispanic Whites
• Acral melanoma represents higher proportion

Black/African American: 1.0 per 100,000

• Approximately 35-fold lower than non-Hispanic Whites
• Acral and mucosal melanomas overrepresented

The Survival Paradox: Lower Incidence, Worse Outcomes

Despite dramatically lower incidence, people of color experience significantly worse melanoma outcomes:[26]

Five-year survival by race:

• Non-Hispanic White patients: 94%
• Hispanic patients: 79%
• Black/African American patients: 70-71%

This 24 percentage point survival gap between White and Black patients represents one of cancer medicine's most severe racial disparities.

Why the Survival Gap Exists

Later stage at diagnosis:

• Black patients: 22% diagnosed at regional stage, 14% at distant stage
• White patients: >50% diagnosed at in situ stage

Anatomic distribution differences:

• In people of color, 60-75% of melanomas occur on non-sun-exposed areas (palms, soles, mucous membranes, nail beds)
• These acral lentiginous melanomas receive less screening attention
• They present diagnostic challenges and may have different biology

Systemic factors:

• Healthcare access disparities
• Lower rates of total body skin examination
• Reduced awareness that melanoma affects all skin types
• Physician education gaps in recognizing melanoma on darker skin

Survival Rates by Stage

Stage at diagnosis remains the single most powerful predictor of melanoma outcomes, far exceeding all other prognostic factors in importance.

Overall Survival Achievements

United States (2015-2021 SEER data):

• All stages combined: 94.7% five-year relative survival
• Dramatic improvement from 82% in 1975—a 12.7 percentage point gain over 42 years[27]

Canada:

• All stages combined: 89% five-year net survival
• Ten-year survival: 87%[28]

Australia:

• All stages combined: 94.1% five-year survival (2016-2020)
• Among the highest in the world[29]

Western/Northern Europe:

• Generally >90% five-year survival in high-income European nations

Stage-Specific Survival: Localized Disease

Localized melanoma (confined to primary site) — 77% of U.S. cases:

Overall localized survival: 98.4-100% five-year relative survival[30]

This near-perfect survival rate for localized disease emphasizes the critical importance of early detection. Patients diagnosed with melanoma confined to the skin have essentially normal life expectancy after appropriate treatment.

AJCC staging breakdown for localized disease:

• Stage 0 (in situ): ~99% five-year survival
• Stage IA: 97% five-year survival
• Stage IB: 92-94% five-year survival
• Stage IIA: 81-87% five-year survival
• Stage IIB: 70-75% five-year survival
• Stage IIC: 68% five-year survival

Thickness (Breslow depth) and ulceration status drive prognostic differences within localized disease. Tumors <1mm thick with no ulceration (Stage IA) carry minimal risk, while thick, ulcerated tumors (Stage IIC) show notably worse outcomes despite lacking documented spread.

Stage-Specific Survival: Regional Disease

Regional disease (spread to nearby lymph nodes) — 10% of U.S. cases:

Overall regional survival: 63.6-75.7% five-year relative survival[31]

The wide range reflects substantial heterogeneity within regional disease based on number of involved lymph nodes, tumor burden, and other factors.

AJCC Stage III breakdown:

• Stage IIIA: 78% five-year survival
• Stage IIIB: 59% five-year survival
• Stage IIIC: 40-53% five-year survival
• Stage IIID: 32% five-year survival

Sentinel lymph node biopsy—a minimally invasive procedure to assess microscopic spread—has revolutionized staging and treatment planning for patients without clinically apparent nodal disease.

Stage-Specific Survival: Distant Metastatic Disease

Distant/metastatic disease (Stage IV) — 5% of U.S. cases:

Historical survival (before modern immunotherapy):

• 2005-2009: 15-18% five-year survival
• Median survival: 6-9 months
• Brain metastases: Median survival 4 months (16 weeks)

Modern survival (with immunotherapy and targeted therapy):

• 2014-2020 SEER data: 34.6% five-year relative survival[32]
• Clinical trial data: 35-52% five-year survival depending on regimen
• Brain metastases with combination immunotherapy: 51% seven-year overall survival[33]

This represents more than doubling of five-year survival for advanced melanoma in just 10-15 years—one of oncology's most dramatic treatment revolutions.

The Immunotherapy Revolution in Numbers

Before 2011 (pre-immunotherapy era):

• Stage IV three-year survival: 4-5%
• Treatment options: Chemotherapy (dacarbazine) with ~15% response rate
• Median overall survival: 6-9 months

After 2011 (immunotherapy era):

• Anti-PD-1 monotherapy (pembrolizumab, nivolumab): 43-50% five-year survival
• Combination immunotherapy (nivolumab + ipilimumab): 49-52% 6.5-year survival
• Median overall survival: Extended to 18-72 months depending on treatment
• Some patients achieve 10+ years cancer-free status—effectively cured

CheckMate 067 landmark trial (10-year data, January 2025):[34]

• Nivolumab + ipilimumab: Median OS 71.9 months (nearly 6 years), 52% five-year survival
• Nivolumab alone: Median OS 36.9 months, 44% five-year survival
• Ipilimumab alone: Median OS 19.9 months, 26% five-year survival

Brain metastases outcomes (ABC trial, 7-year data, February 2025):[35]

• Combination therapy: 47% seven-year PFS, 51% seven-year OS
• Patients previously given median 16-week survival now achieving multi-year remissions
• Researchers using term "cured" for first time in melanoma brain metastases

Melanoma Subtypes and Molecular Characteristics

Not all melanomas behave identically. Understanding melanoma subtypes helps predict behavior, guide treatment selection, and inform prognosis.

Major Histologic Subtypes

Superficial Spreading Melanoma

• Frequency: ~70% of all melanomas
• Characteristics: Most common type, typically arises in younger patients
• Location: Can occur anywhere but common on trunk (men) and legs (women)
• Growth pattern: Horizontal (radial) growth phase before vertical invasion
• Prognosis: Generally favorable if caught early

Nodular Melanoma

• Frequency: 15-30% overall
• Critical statistic: Represents 40-50% of thick melanomas (>2mm depth)[36]
• Characteristics: Aggressive, rapid vertical growth from onset
• Appearance: Raised, dome-shaped, often amelanotic (non-pigmented)
• Prognosis: Worse than superficial spreading due to rapid invasion

Lentigo Maligna Melanoma

• Frequency: 10-15%
• Characteristics: Arises in chronically sun-damaged skin
• Location: Face, neck, ears, arms of elderly patients
• Growth pattern: Very slow horizontal growth for years before invasion
• Prognosis: Generally good if wide surgical excision performed

Acral Lentiginous Melanoma

• Frequency in White populations: <5%
• Frequency in Japanese populations: 40.8%[37]
• Location: Palms, soles, nail beds, mucous membranes
• Characteristics: Not UV-related; different biology
• Prognosis: Often diagnosed late; worse outcomes than superficial spreading
• Importance: Most common melanoma type in people of color

Rare Melanoma Subtypes

Mucosal Melanoma

• Frequency: 1-2% of all melanomas
• Locations: Oral cavity, nasal passages, GI tract, genitourinary tract
• Five-year survival: Only 25%[38]
• Challenge: Difficult to detect early; poorer response to immunotherapy

Uveal (Ocular) Melanoma

• Frequency: <2% of melanomas
• Annual incidence: ~150 cases in Canada, ~4,000 globally[39]
• Characteristics: Arises in eye (uveal tract); completely different biology from cutaneous
• Metastasis pattern: Liver-predominant spread
• Treatment: Specialized approaches including tebentafusp (T-cell engager)

Desmoplastic Melanoma

• Frequency: <4% of cases
• Characteristics: Spindle cell morphology, fibrotic stroma
• Behavior: Higher local recurrence, lower regional spread
• Immunotherapy response: Often excellent (high tumor mutational burden)

Molecular Characteristics: BRAF and Beyond

BRAF Mutations

Frequency: Present in 40-50% of all melanomas[40]

Mutation types:

• BRAF V600E: 83% of BRAF-positive melanomas (most common)
• BRAF V600K and other V600 variants: 13% of BRAF-positive
• Non-V600 BRAF mutations: 4% (not targetable with current drugs)

Clinical significance:

• Determines eligibility for BRAF/MEK inhibitor targeted therapy
• Correlates with younger age at diagnosis
• Associates with intermittent sun exposure pattern
• Testing recommended for all advanced melanoma patients

Other Actionable Mutations

NRAS mutations:

• Present in 15-20% of melanomas
• Mutually exclusive with BRAF
• Currently no approved targeted therapy (clinical trials ongoing)

KIT mutations:

• Present in 15-25% of acral and mucosal melanomas
• <5% of cutaneous melanomas
• Targetable with imatinib in select cases

NF1 mutations:

• Present in ~15% of melanomas
• Associated with older age, chronic sun damage
• Currently no specific targeted therapy

Tumor Mutational Burden

Melanoma typically exhibits high tumor mutational burden (TMB) due to UV-induced DNA damage, averaging 10-20 mutations per megabase. High TMB correlates with:

• Better response to immune checkpoint inhibitors
• Creation of neoantigens recognized by immune system
• Explanation for melanoma's exceptional immunotherapy responsiveness

Treatment Revolution and Outcomes

The melanoma treatment landscape has undergone a complete transformation since 2011, when the FDA approved ipilimumab—the first immune checkpoint inhibitor for any cancer. This section details the therapies driving survival improvements documented earlier.

Immune Checkpoint Inhibitors: The Foundation

PD-1 Inhibitors (Monotherapy)

Pembrolizumab (Keytruda):[41]

• FDA approved 2014 for advanced melanoma
• Response rate: 30-45%
• Five-year overall survival: 40-45%
• Complete response rate: 30-40%
• Median overall survival: 17.4 months (real-world data)

Nivolumab (Opdivo):

• FDA approved 2014 for advanced melanoma
• Response rate: 32-44%
• Median overall survival: 20 months
• Five-year overall survival: 44%
• Direct comparison: No significant difference versus pembrolizumab

Mechanism: PD-1 inhibitors block the PD-1/PD-L1 interaction that cancer cells exploit to evade immune detection, unleashing T-cell antitumor activity.

Combination Immunotherapy

Nivolumab + Ipilimumab (dual checkpoint blockade):[42]

The CheckMate 067 trial's 10-year follow-up (published January 2025 in New England Journal of Medicine) established combination therapy as superior to monotherapy:

• Median overall survival: 71.9 months (5.99 years)
• Five-year overall survival: 52%
• Ten-year overall survival: 43%
• Grade 3-4 adverse events: 59% (versus 21% for nivolumab alone)

Comparison with monotherapy:

• Nivolumab alone: 36.9 months median OS, 44% five-year OS
• Ipilimumab alone: 19.9 months median OS, 26% five-year OS

Trade-off: Superior efficacy balanced against higher toxicity requiring careful patient selection.

LAG-3 Blockade

Relatlimab + Nivolumab (Opdualag):[43]

• FDA approved March 2022
• First dual checkpoint inhibitor combining LAG-3 and PD-1 blockade
• RELATIVITY-047 trial: Median PFS 10.1 months vs 4.6 months (nivolumab alone)
• Lower toxicity than ipilimumab combinations
• Expanding immunotherapy options for patients

Cellular Therapy: The New Frontier

Lifileucel (Amtagvi) — Tumor-Infiltrating Lymphocyte (TIL) Therapy:[44]

FDA approved February 2024 as the first cellular therapy for any solid tumor cancer, lifileucel represents a paradigm shift in melanoma treatment.

Process:

1. Surgical harvest of tumor tissue
2. Ex vivo expansion of patient's tumor-reactive T cells
3. Lymphodepleting chemotherapy
4. Reinfusion of billions of expanded TILs
5. IL-2 support therapy

Five-year efficacy data (C-144-01 trial, ASCO 2025):

• Objective response rate: 31.4%
• Complete response: 5.9%
• Partial response: 25.5%
• Median duration of response: 36.5 months
• Tumor shrinkage: 79.3% of patients
• Patients remaining in response at 5 years: 31.4%

Limitations:

• Cost: $515,000 per patient
• Requires specialized centers
• One-time treatment (versus ongoing checkpoint inhibitor therapy)
• Canadian Health Canada approval: August 2025

Targeted Therapy for BRAF-Mutant Melanoma

For the 40-50% of patients with BRAF V600 mutations, targeted therapy offers alternative to immunotherapy.

BRAF/MEK inhibitor combinations:[45]

Dabrafenib + Trametinib (Tafinlar + Mekinist):

• Response rate: 64-69%
• Median PFS: 11-12 months
• Median OS: 25-26 months
• Rapid response (often within weeks)

Vemurafenib + Cobimetinib (Zelboraf + Cotellic):

• Response rate: 70%
• Median PFS: 12.3 months
• Similar efficacy profile to dabrafenib/trametinib

Encorafenib + Binimetinib (Braftovi + Mektovi):

• Response rate: 63-75%
• Median PFS: 14.9 months
• Favorable side effect profile

Critical sequencing decision (DREAMseq trial):[46] The DREAMseq trial definitively established optimal treatment sequence:

• Immunotherapy first → targeted therapy second: 72% two-year OS
• Targeted therapy first → immunotherapy second: 52% two-year OS

This 20 percentage point survival advantage establishes immunotherapy-first as standard for most BRAF-mutant patients, reserving targeted therapy for those who progress or cannot tolerate immunotherapy.

Oncolytic Viral Therapy

Talimogene laherparepvec (T-VEC, Imlygic):

• FDA approved 2015 for unresectable regional/distant melanoma
• Intralesional injection of modified herpes virus
• Induces local and abscopal (distant) responses
• Often combined with checkpoint inhibitors

RP1 (vusolimogene oderparepvec) + nivolumab:[47]

• Oncolytic immunotherapy in late-stage development
• BLA resubmission accepted by FDA
• PDUFA target action date: April 10, 2026
• Combination with PD-1 inhibitor shows promising results

Adjuvant Therapy for High-Risk Resected Melanoma

Adjuvant therapy after surgical resection of high-risk melanoma has become standard of care, reducing recurrence risk substantially.

Approved adjuvant regimens (Stage III/high-risk Stage II):

Pembrolizumab:[48]

• Reduces recurrence risk by 35-40%
• Distant metastasis-free survival benefit
• Cost-effectiveness: $15,009 per QALY gained (highly favorable)
• Generates 3.39 additional life-years
• 90.2% probability of cost-effectiveness at $100,000/QALY threshold

Nivolumab:

• Similar efficacy to pembrolizumab
• European cost-effectiveness: €21,153 per QALY (most cost-effective option)[49]
• One-year treatment duration

Dabrafenib + Trametinib (BRAF-mutant only):

• Reduces recurrence risk by 47%
• European cost-effectiveness: €37,520 per QALY
• Alternative for BRAF-mutant patients

Treatment duration: Typically 12 months of adjuvant therapy balances efficacy and toxicity.

Geographic and Ethnic Variations

Australia and New Zealand: Global Epicenter

Australia maintains the highest melanoma burden worldwide, with age-standardized incidence rates reaching:[50]

2025 Australian projections:

• Males: ~78 per 100,000
• Females: ~50 per 100,000
• Individuals aged 80+: >300 per 100,000

New Zealand:

• Age-standardized rate: 32.40 per 100,000 (highest globally for national averages)

Reasons for extreme rates:

• Predominantly fair-skinned population (European ancestry)
• High ambient UV radiation (latitude 25-45°S)
• Outdoor lifestyle and historical lack of sun protection
• Ozone depletion over Southern Hemisphere

Success story: Australia's comprehensive "Slip, Slap, Slop" public health campaign (slip on a shirt, slap on a hat, slop on sunscreen) launched in 1980s has demonstrated measurable impact:

• Declining incidence in ages 20-44: 41.7% reduction in males, 47.9% in females
• Stable or declining rates in ages 45-64
• Continued increases only in oldest cohorts (accumulated exposure)

European Patterns

Northern Europe (highest European rates):

• Norway: 29.6 per 100,000
• Denmark: 31.10 per 100,000
• Sweden: 22-24 per 100,000
• Finland: 18-20 per 100,000

Western Europe:

• Netherlands: 24-26 per 100,000
• Germany: 20-22 per 100,000
• United Kingdom: 18-20 per 100,000
• France: 14-16 per 100,000

Southern Europe (lower rates despite higher UV):

• Spain: 8-10 per 100,000
• Italy: 12-14 per 100,000
• Greece: 6-8 per 100,000

The paradox of lower rates in higher-UV Southern Europe reflects darker skin phenotypes (Fitzpatrick types III-IV predominant versus I-II in Northern Europe) and possibly more continuous sun exposure leading to tanning rather than intermittent burning.

Asian Patterns and Alarming Trends

Current incidence:

• Most Asian countries: 0.5-3 per 100,000
• Japan: 1.5-2 per 100,000
• South Korea: 2-3 per 100,000
• China: 0.5-1 per 100,000

Acral melanoma predominance: In Asian populations, acral lentiginous melanoma represents the most common subtype (40.8% in Japanese data)[51], contrasting with the <5% frequency in Caucasian populations. This non-UV-associated subtype has distinct biology and treatment implications.

Most concerning trend: East Asia shows the highest global melanoma increase at +4.42% annually[52] for overall skin cancers, with China specifically demonstrating +4.47% annual ASIR increase. This rapid burden growth reflects:

• Population aging
• Increasing UV exposure awareness and diagnosis
• Adoption of Western lifestyle patterns
• Improved cancer surveillance systems

Projections: Without intervention, Asian melanoma burden may double by 2040, representing millions of cases in absolute terms given large population denominators.

African Patterns

Current incidence:

• Most Sub-Saharan African countries: 0.3-2 per 100,000
• South Africa: 3-5 per 100,000 (higher in White minority population)
• North Africa: 2-4 per 100,000

Acral and mucosal predominance: Among African populations, non-cutaneous forms (acral, mucosal) predominate, comprising >70% of melanomas. These carry worse prognosis and respond less well to immunotherapy.

Albinism factor: Sub-Saharan Africa faces a unique melanoma risk factor: oculocutaneous albinism affects approximately 1 in 5,000-15,000 individuals in some regions. Individuals with albinism in equatorial Africa face extreme UV exposure without melanin protection, experiencing:

• Melanoma incidence >100-fold higher than general African population
• Median age at melanoma diagnosis: 20-30 years
• High proportion of head/neck melanomas
• Often lack access to sunscreen and protective clothing

Latin American Variations

Higher-incidence countries:

• Uruguay: 10-12 per 100,000
• Argentina: 8-10 per 100,000
• Brazil (southern regions): 6-8 per 100,000

Lower-incidence countries:

• Mexico: 2-3 per 100,000
• Central American nations: 1-2 per 100,000
• Andean countries: 2-4 per 100,000

Latin American melanoma patterns reflect complex interplay of:

• Latitude and UV index variation
• Population genetic admixture (European, Indigenous, African ancestry)
• Socioeconomic factors affecting sun protection and healthcare access
• Occupational outdoor exposure without protection

Trends and Future Projections

Concerning Upward Incidence Trends

United States Long-term Trajectory

From 1999 to 2021, U.S. melanoma incidence rose from 15.1 per 100,000 to 23.0 per 100,000—a 52% increase over 22 years.[53] Key patterns:

Continuing increases:

• Adults aged 40+: +1.8% annual percentage change in both men and women
• Overall population: +1.2% average annual increase (2013-2022)
• Cumulative effect: 42% increase from 2015 to 2025 (73,870 to 104,960 cases)

Stabilization or decline in younger populations:

• Women under 50: Rates stabilizing after decades of sharp increases
• Men under 50: Declining approximately 1% per year

This bifurcation suggests prevention messages may be reaching younger cohorts (born after widespread sun protection awareness), while older cohorts continue manifesting cumulative lifetime UV damage.

Canada's Unprecedented 17% Single-Year Jump

Canada's 17% increase from 2023 to 2024 (9,650 to 11,300 cases) represents the highest single-year melanoma increase in recent Canadian cancer surveillance.[54] Potential explanations:

1. True incidence increase (concerning if validated)
2. Catch-up diagnosis post-COVID-19 pandemic (delayed presentations)
3. Enhanced detection from screening programs
4. Statistical variation (may normalize in subsequent years)
5. Population demographics (aging baby boomers)

Continued monitoring through 2025-2026 will clarify whether this represents a sustained acceleration or a one-time artifact. If sustained, it suggests a critical need for intensified prevention efforts.

Young Women: A 50% Increase Since 1980

Among women under age 30, melanoma incidence has increased approximately 50% since 1980,[55] making melanoma one of the few cancers rising in this demographic. Primary driver: Indoor tanning device use.

Indoor tanning statistics:[56]

• 36% of U.S. adults have used tanning devices in lifetime
• 55% of college students report tanning bed use
• 19% of teenagers have used tanning beds
• 52.5% of users began before age 21
• 44% of users starting before age 16 did so with a family member

Risk magnitude: Women under 30 using tanning beds face 6-fold increased melanoma risk. This modifiable risk factor represents a clear target for prevention.

Positive Mortality Trends

Despite rising incidence, mortality trends provide genuine optimism:

United States:

• Death rates declining 2.8% per year (2014-2023)
• Sharper declines in younger populations: 5% annually in adults <50
• Mortality reductions across all demographic groups

Canada:

• First sustained mortality decline beginning 2013
• Reversal of previous increasing trend
• Attributes to immunotherapy access and earlier detection

Australia:

• 40-50% mortality reduction over recent decades
• Success attributed to comprehensive prevention programs and early detection initiatives

Western/Northern Europe:

• Generally stable or declining mortality across high-income European nations
• Regional variation reflects healthcare system differences and treatment access

Global Burden Projections to 2040

A 2022 modeling study published in JAMA Dermatology projected melanoma burden to 2040:[57]

Projected 2040 global melanoma statistics:

• 510,000 new cases (50% increase from 2020's 331,000)
• 96,000 deaths (68% increase from 2020's 58,000)

Regional growth patterns:

• Highest absolute growth: Asia (due to population size and rising rates)
• Highest percentage growth: Eastern Europe, Middle East, Central Asia
• Stabilization: Australia, parts of Northern Europe

Required intervention for stabilization: Incidence rates would need to decrease by more than 2% annually just to stabilize absolute case numbers—a target that current trends suggest is unlikely without major prevention breakthroughs.

Drivers of Future Burden

Population aging:

• Global population aged 60+ projected to double by 2050
• Melanoma risk increases exponentially with age
• Aging alone will drive substantial burden increase

Cumulative UV exposure:

• Cohorts born before 1980 (pre-sun protection awareness) continue accumulating risk
• Manifestation of exposures decades earlier
• Will persist for 20-30 more years

Climate change effects:

• Potential increases in UV radiation
• Behavioral changes (more outdoor activity)
• Geographic shifts in high-risk zones

Tanning culture persistence:

• Indoor tanning continues despite evidence
• Social media influences on appearance ideals
• Inadequate regulation in many jurisdictions

Reasons for Optimism

Treatment advances continue:

• New checkpoint inhibitors in development
• Personalized neoantigen vaccines showing promise
• Cellular therapies expanding
• Combination strategies improving

Earlier detection:

• AI-assisted dermoscopy improving accuracy
• Total body photography becoming more accessible
• Self-examination campaigns increasing awareness
• Smartphone apps enabling monitoring

Prevention progress:

• Declining rates in younger cohorts suggesting messaging works
• Tanning bed bans for minors in some jurisdictions
• Workplace sun safety programs expanding
• School-based education initiatives

Healthcare system responses:

• Specialized melanoma centers proliferating
• Multidisciplinary tumor boards standard
• Clinical trial access expanding
• Telemedicine enabling rural consultations

Key Takeaways for Healthcare Providers and Patients

For Healthcare Providers

Clinical Practice Points

1. Early detection remains paramount: With 99%+ five-year survival for localized melanoma versus 35% for distant disease, detection timing profoundly impacts outcomes.
2. Perform total body skin examinations: Particularly for high-risk patients (fair skin, multiple nevi, family history, immunosuppression, prior skin cancer).
3. Remember acral and mucosal sites: Especially in patients of color, where 60-75% of melanomas occur on non-sun-exposed areas (palms, soles, nail beds, mucous membranes).
4. Age-appropriate counseling: Young women need indoor tanning deterrence; older adults need cumulative exposure risk discussion; all ages need sun protection education.
5. BRAF testing mandatory for advanced disease: Determines treatment options and optimal sequencing (immunotherapy first generally preferred).
6. Adjuvant therapy discussion for high-risk resected: Stage III and high-risk Stage II patients should receive counseling about adjuvant immunotherapy or targeted therapy.
7. Recognize the gender mortality gap: Men face 43-85% higher melanoma mortality; consider more aggressive screening and education for male patients.

Referral Thresholds

Refer to dermatology for:

• New or changing pigmented lesions fitting ABCDE criteria
• Any lesion concerning to patient or provider
• Patients with >50 moles or atypical nevi
• Personal history of melanoma (annual surveillance)
• First-degree relatives of melanoma patients

Refer to medical oncology for:

• Stage IIB or higher melanoma (adjuvant therapy consideration)
• Any recurrent melanoma
• Stage IV disease (immediate referral for immunotherapy evaluation)

For Patients and the Public

Risk Reduction Strategies

Sun protection:

• Broad-spectrum SPF 30+ sunscreen daily, reapplied every 2 hours outdoors
• Protective clothing (long sleeves, wide-brimmed hats)
• Seek shade during peak UV hours (10am-4pm)
• Sunglasses with UV protection

Avoid indoor tanning:

• No safe amount of indoor tanning exists
• Tanning beds increase melanoma risk 6-fold in young women
• Alternatives: Spray tans, self-tanning products

Self-examination:

• Monthly head-to-toe skin checks
• Use mirrors or partner assistance for back, scalp
• ABCDE rule: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving
• Photograph suspicious lesions to track changes

Professional screening:

• Annual skin examination by dermatologist for high-risk individuals
• Baseline examination at any age with concerning lesion
• More frequent follow-up if personal history of melanoma

Understanding Your Risk

Higher risk if you have:

• Fair skin that burns easily, rarely tans
• Red or blonde hair
• Blue or green eyes
• More than 50 moles
• Atypical (dysplastic) moles
• Personal history of melanoma or non-melanoma skin cancer
• Family history of melanoma
• History of severe sunburns (especially childhood/adolescent)
• History of indoor tanning
• Immunosuppression
• Living in or frequent travel to high-UV regions

Risk persists across all skin types:

• While melanoma is less common in people of color, outcomes are significantly worse due to later detection
• All individuals regardless of skin color should perform self-examinations and seek evaluation of concerning lesions

What to Do if Diagnosed

1. Seek specialized care: Melanoma treatment has evolved rapidly; ensure oncologists are current with immunotherapy advances.
2. Understand your stage: Stage determines prognosis and treatment approach.
3. BRAF testing: If Stage III or IV, ensure BRAF mutation testing occurs—determines treatment options.
4. Consider clinical trials: Melanoma has robust clinical trial landscape; new treatments may offer advantages.
5. Plan for surveillance: Even after successful treatment, lifelong follow-up is necessary (5-10% risk of second primary melanoma).
6. Address psychosocial needs: Melanoma diagnosis creates substantial anxiety; support resources available through cancer centers and patient advocacy organizations.
7. Protect remaining skin: After one melanoma, risk of additional primaries is elevated—redouble sun protection efforts.

Population-Level Recommendations

For Public Health Authorities

1. School-based sun safety education: Target children aged 5-10 before peak risk-taking adolescence.
2. Tanning bed regulation: Enforce bans on indoor tanning for minors; consider adult restrictions.
3. Workplace sun safety programs: Mandate for outdoor occupations (construction, agriculture, landscaping).
4. Healthcare provider education: Include melanoma recognition in darker skin types in medical training.
5. Eliminate cost barriers: Remove sales tax on sunscreen; provide free sunscreen in public spaces.
6. Expand screening access: Address dermatology workforce shortages; support mobile screening initiatives like Canada's Mole Mobile.
7. Culturally appropriate messaging: Tailor prevention and detection campaigns to reach diverse communities effectively.

For Health Systems

1. Implement screening protocols: Systematic total body skin examination for high-risk patients.
2. Rapid diagnostic pathways: Minimize time from suspicious lesion identification to biopsy to treatment.
3. Multidisciplinary melanoma programs: Coordinated care teams including dermatology, surgical oncology, medical oncology, radiation oncology.
4. Treatment access: Ensure immunotherapy and cellular therapies available; assistance programs for financial barriers.
5. Survivorship programs: Long-term surveillance protocols; second primary prevention education.
6. Data collection: Contribute to cancer registries to enable ongoing surveillance and research.

Conclusion

Melanoma in 2025 presents a disease in transition. Incidence continues climbing globally, with the United States projecting 104,960 new cases (up 4.3% from 2024) and Canada reporting an unprecedented 17% year-over-year increase to 11,300 cases in 2024. Young women under age 50 now face 82% higher melanoma incidence than their male peers—a dramatic reversal of historical patterns driven largely by indoor tanning.

Yet these concerning incidence trends unfold against a backdrop of remarkable treatment success. Five-year survival for advanced Stage IV melanoma has more than doubled from 15% to 35-50% in just 15 years, driven by checkpoint inhibitor immunotherapies, targeted molecular treatments, and now cellular therapies like TIL. The CheckMate 067 trial's 10-year data showing median overall survival of 71.9 months with combination immunotherapy represents outcomes unimaginable a generation ago. Some patients with melanoma brain metastases—historically fatal within 4 months—now achieve 51% seven-year survival, with researchers using the word "cured" for the first time in this context.

Early detection remains paramount: localized melanoma carries 99% five-year survival versus 35% for distant disease. Yet profound disparities persist. Black patients face 24 percentage points lower five-year survival than White patients (70% versus 94%), driven primarily by later-stage diagnosis of melanomas occurring disproportionately on palms, soles, and other non-sun-exposed sites that receive less screening attention. Men experience 43-85% higher melanoma mortality than women despite only modestly higher incidence, reflecting both anatomic distribution differences and potentially delayed care-seeking.

Geographic variations underscore melanoma's complexity: Australia's rates of 50-78 per 100,000 dwarf Canada's 14-21 per 100,000, which in turn exceed Asia's 0.5-3 per 100,000. Yet East Asia shows the world's fastest growth at +4.42% annually, suggesting melanoma's burden will increasingly globalize. Prince Edward Island's extraordinary Canadian rate of 33.86 per 100,000—exceeding even U.S. averages—demands investigation of local risk factors.

Projections to 2040 estimate 510,000 global cases (up 50%) and 96,000 deaths (up 68%) without intervention. Achieving the 2% annual incidence decline necessary to stabilize absolute case numbers requires comprehensive prevention: school-based sun safety education, tanning bed restrictions, workplace protections for outdoor workers, and elimination of cost barriers to sunscreen.

The path forward balances prevention and innovation. Declining incidence in younger cohorts where sun protection messaging has penetrated offers proof that behavioral interventions work. Continued therapeutic advances including LAG-3 inhibitors, oncolytic viral therapies, personalized neoantigen vaccines, and refined cellular therapy approaches promise further survival gains. Artificial intelligence-assisted dermoscopy may revolutionize early detection. Mobile screening programs like Canada's Mole Mobile and Australia's targeted screening roadmap model innovative access solutions.

Ultimately, melanoma's dual narrative—rising incidence, improving outcomes—demands dual responses. Public health must intensify primary prevention to reverse incidence trends, particularly among high-risk groups and emerging burden regions. Clinical medicine must ensure all patients access the life-saving treatments that have transformed advanced melanoma from a death sentence into a potentially curable disease. Addressing disparities in both prevention and treatment remains imperative: melanoma should not exhibit a 24 percentage point racial survival gap in 2025.

The data presented here—drawn from authoritative sources including national cancer societies, SEER, GLOBOCAN, and peer-reviewed literature—provides the foundation for evidence-based action. Healthcare providers, public health authorities, policymakers, and individuals all have roles in bending melanoma's trajectory toward falling incidence to match falling mortality. The tools exist; the question is whether societies will deploy them with the urgency this preventable yet increasingly common cancer demands.

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Disclaimer: This article synthesizes publicly available statistical data and peer-reviewed research current as of October 2025. Medical information changes rapidly; readers should consult healthcare providers for personalized medical advice. Statistics represent estimates and projections subject to revision as more complete data becomes available.

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