Skin Cancer Mortality Trends Among Older Americans aged ≥65 years: A 25-Year Analysis (1999-2023)

Abstract Background: Skin-cancer deaths among Americans aged ≥65 continue to rise despite immunotherapy and screening; monitoring mortality can guide prevention, early detection, and equitable care. Methods: We used CDC WONDER Multiple Cause-of-Death files (1999–2023) to identify malignant melanoma and keratinocyte cancers (ICD-10 C43–C44) among adults ≥65. Age-adjusted mortality rates (AAMRs) were standardized to the 2000 U.S. population. Joinpoint regression (α=0.05; ≤4 joinpoint) estimated annual percent change (APC) overall and by sex, race/ethnicity, U.S. Census region, and 2013 urban–rural category. Results: Between 1999 and 2023, 249,811 skin-cancer deaths occurred among adults ≥65 years. The AAMR rose from 20.9 in 1999 to 25.3 in 2023 (1999–2014 APC: 1.12; 95% CI: 0.85–1.38), showed no significant change in 2014–2017 (APC: −2.93; 95% CI: −8.58 –3.07), then increased in 2017–2023 (APC: 2.42; 95% CI: 1.43–3.42), peaking in 2021 at 25.8 and remaining elevated through 2023. Men had higher AAMR than women (overall 37.4 vs 13.1 per 100,000); female rates were stable to 2019, then increased (2019–2023 APC: 3.06; 95% CI: 0.76–5.41). In 2023, AAMR was highest in non-Hispanic White adults (31.6), followed by Hispanic or Latino (7.9), non-Hispanic Black (4.5), and non-Hispanic Others (3.9). Race-specific trends: NH White increased pre-2014 and post-2017; Hispanic stable; NH Black declined to 2017 then showed no significant change in 2017–2023; NH Others declined modestly. AAMR varied by region (West 24.2; South 23.3; Midwest 22.2; Northeast 21.6), and nonmetropolitan areas had higher AAMR than metropolitan areas (25.0 vs 22.2). Conclusions: Skin-cancer mortality in Americans ≥65 remained elevated through 2023, peaking in 2021, with highest burdens in men, nonmetropolitan counties, and Western states. Because this is an observational analysis of combined C43/C44 deaths, any alignment of segments with therapy adoption or the pandemic is descriptive and hypothesis-generating, not causal. Targeted screening, sun-safety education, workforce incentives, and tele-dermatology outreach may help reduce the burden while drivers are clarified.