Socioeconomic Influences on Melanoma Incidence Patterns by Stage in the US

Background and Objectives: Melanoma is one of the fastest-growing cancers in the United States, with nearly 100% 5-year survival for early-stage disease compared to 35% for late-stage disease. Regional studies suggest that areas with increased early-stage melanoma diagnoses may not experience a reduction in late-stage cases, raising questions about the effectiveness of early detection. We hypothesize that higher socioeconomic status (SES) will correlate with increased early-stage melanoma without a decrease in late-stage disease, with geographic variation across US regions. Methods: This cross-sectional study used SEER data to analyze 829 391 non-Hispanic White patients diagnosed with melanoma between 2004 and 2021, including 725 077 with early-stage (in situ/localized) and 104 314 with late-stage (regional/distant) disease. Regression models evaluated associations between county-level stage-specific melanoma incidence and population characteristics, including SES, ultraviolet exposure, agricultural employment, and rural-urban status. Results: Higher SES counties had higher early-stage melanoma incidence without a reduction in late-stage incidence. Counties in the West and South had increased odds of early-stage melanoma, while rural counties exhibited lower melanoma incidence across stages. Agricultural employment and ultraviolet exposure were not consistently associated with melanoma incidence. Conclusion: Findings suggest early- and late-stage melanoma may represent distinct diseases. Screening may aid in early detection, but its impact on reducing late-stage disease and mortality remains uncertain.