Melanoma disproportionately impacts Florida's senior population

Florida's year-round sunshine and intense ultraviolet (UV) exposure help drive one of the nation's heaviest skin cancer burdens, with older adults shouldering much of the impact. A new study from Florida Atlantic University's Charles E. Schmidt College of Medicine shows that melanoma – the deadliest form of skin cancer – continues to disproportionately affect Florida's senior population, revealing persistent gaps in both diagnosis and mortality across sex, race and ethnic groups.

As the Sunshine State has the nation's second-highest melanoma incidence rate, the findings provide one of the most comprehensive recent assessments of skin cancer trends among Florida residents ages 65 and older.

FAU researchers conducted a population-based analysis of skin cancer incidence and mortality among Florida adults age 65 and older using data from the CDC's WONDER (Wide-ranging Online Data for Epidemiologic Research) database. The study examined diagnoses from 2018 to 2021 and deaths from 2018 to 2023, with trends analyzed by age, sex, race and ethnicity. Basal cell carcinoma and squamous cell carcinoma were excluded to focus on melanoma and other less common but more clinically aggressive skin cancers.

The results, published in the Journal of Geriatric Oncology, revealed a consistent and striking pattern: older men in Florida experienced roughly twice as many skin cancer-related deaths as women across all years analyzed. Incidence rates and mortality patterns remained relatively stable over time, but the sex-based gap persisted throughout the study period.

Researchers attribute this disparity to a complex combination of factors, including lower rates of sun-protective behaviors and skin self-examinations among men, higher cumulative lifetime UV exposure in Florida's high-risk environment, and emerging evidence suggesting that biological sex differences in immune system function may influence cancer progression and survival outcomes.

Racial and ethnic disparities were also pronounced. Non-Hispanic populations experienced significantly higher rates of skin cancer diagnoses and deaths than Hispanic populations, with melanoma and other skin cancers occurring most frequently among white residents.

However, researchers caution that these patterns may reflect a combination of true differences in risk as well as structural and social factors, including variations in access to dermatologic care, differences in health literacy, and disparities in how and where skin cancers are detected and diagnosed.

The study also suggests that observed declines in incidence in certain years may reflect disruptions in screening, diagnosis and reporting during the COVID-19 pandemic rather than a true reduction in disease burden. Across multiple categories, incidence rates were lowest in 2020, followed by a rebound in 2021, consistent with pandemic-related interruptions in healthcare access and cancer detection.

Taken together, our findings suggest that skin cancer in Florida is driven not only by ultraviolet exposure, but also by behavioral patterns, biological factors and persistent gaps in prevention and early detection – particularly among older men."

Lea Sacca, Ph.D., senior author and assistant professor of population health, Schmidt College of Medicine

The study shows that these disparities remain consistent in both incidence and mortality, underscoring an uneven burden of disease across Florida's aging population and the need for more tailored, population-specific prevention strategies.

"Men appear to bear a disproportionate share of both disease and death, which may reflect differences in preventive behaviors, health-seeking patterns, and possibly underlying biological susceptibility that warrants further investigation," Sacca said. "These differences cannot be fully explained by UV exposure alone, pointing to a combination of behavioral and biological factors."

While Florida's elevated UV exposure likely increases melanoma risk statewide, researchers note it does not fully explain why certain groups experience markedly worse outcomes.

"The patterns we are seeing point to missed opportunities in prevention and early detection," said Sacca. "Improving awareness of skin cancer risk, encouraging routine skin checks, and expanding culturally responsive education are critical steps toward reducing these disparities and improving outcomes across the state."

With summer underway, temperatures rising, and beach season in full swing, researchers emphasize that the combination of high UV exposure, an aging population, and gaps in preventive care makes this an especially urgent public health concern. They add that stronger public health messaging, earlier screening, and targeted outreach will be essential to reducing what is largely a preventable cancer burden among Florida's rapidly growing older adult population.