Demographic and Regional Trends in Nonmelanoma Skin Cancer Mortality in the United States, 1999-2020

Background Nonmelanoma skin cancer (NMSC) is the most common malignancy worldwide, yet the United States lacks a dedicated registry to monitor its mortality. We aimed to characterize temporal trends and demographic and regional disparities in age-adjusted NMSC mortality in the U.S. from 1999 through 2020. Methods We conducted a retrospective analysis of CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database from 1999 to 2020 for NMSC. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race, age group, and geographic region. Results A total of 68,223 NMSC-related deaths occurred. Overall AAMR increased from 0.845 (95% CI 0.810–0.879) in 1999 to 1.002 (0.971–1.032) in 2020. Trends showed an initial decline (1999–2004 APC − 0.7%), followed by a rise (2004–2020 APC 1.6%). Men had higher mortality than women (1.55 vs 0.43 per 100,000), with significant increases in both sexes (men 1999–2016 APC 1.4%; women 2011–2020 APC 2.5%). NH White individuals exhibited the highest AAMR (1.03) and steepest rise (2005–2015 APC 2.8%), while NH Blacks declined (APC − 1.5%) and Hispanics increased modestly (APC 0.9%). Those ≥ 65 years had the highest AAMR (5.63). Regionally, the South (1.01) and rural areas (1.04) bore the greatest burden, with persistent increases (rural APC 1.7%; suburban APC 1.4%). Conclusions Despite diagnostic and therapeutic advances, U.S. NMSC mortality has risen, with marked demographic and geographic disparities. Enhanced mortality surveillance, targeted prevention efforts, and equitable access to dermatologic care are needed to mitigate this growing public health burden.