Overview of Melanoma in Veterans

Considerations Regarding Epidemiology, Risk Factors, Diagnosis, Prognosis, Survival, and Treatment

Introduction

Distinct health challenges affect veterans both during and after military service, which are associated with greater morbidity compared to the general U.S. population. According to results from one study using the U.S. Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System dataset from 2003 to 2009, veterans have higher rates of self-reported morbidities including cancer.¹ Skin cancer, and melanoma in particular, are significant challenges in veterans. This article provides an overview of recent information on epidemiology, risk factors, diagnosis, prognosis, survival, and treatment options with the goal of increasing awareness to help support veteran patient outcomes.

Increased Likelihood of Developing Melanoma

Results from a 2024 study with 61,307 participants using National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018 showed that the likelihood of skin cancer diagnoses was higher in U.S. veterans than in nonveterans, and melanoma had most significant increase across the three skin cancer subcategories.² In total, 54,554 nonveterans and 6,753 veterans were included in the study. The prevalence of any skin cancer history among U.S. veterans was 9.0% vs 2.9% in nonveterans, which represents an increase of approximately three times.² In addition, the prevalence of melanoma history was 2.2% vs 0.6%, which represents an increase of approximately four times.²

“The prevalence of melanoma history in veterans is approximately four times higher than in nonveterans.”

Risk Factors for Developing Melanoma

Extreme sun exposure and lack of protection against ultraviolet radiation during active military service are risk factors for developing melanoma in veterans compared to the general U.S. population.^2,3 This multifactorial challenge originates from problems such as inadequate access to sunscreen, insufficient emphasis on sun protection, exposure to harsh weather conditions, and the need to prioritize immediate safety concerns over preventive care.^2,3 Indeed, deployment locations over the last four decades have included multiple middle eastern countries, which are particularly sun intensive, but it is also important to consider that many bases in the U.S. are also in sun intensive locations. Training and deployment in these areas, without proper protection, contributes to the risks our veterans experience. Additionally, the U.S. military population has demographic characteristics that are associated with a higher likelihood of developing melanoma. For example, most of the population is male, older, and White.^2,3 Together, these risk factors indicate why we see an increased rate of skin cancer, and specifically melanoma, in our military.

Considerations for Diagnosis, Prognosis, and Survival

Perhaps not surprisingly, results show that the veteran population presents with more advanced disease when first diagnosed. Results from a 2022 study with data collected from the Veterans Affairs Cancer Registry (VACR) and the Surveillance, Epidemiology, and End Results (SEER) program from 2009 to 2017, support this finding.⁴ This study identified a total of 15,334 veterans and 166,265 SEER patients with melanoma. Veterans were more likely to present with regional or distant disease (Stage III or Stage IV) compared to patients from the general population (17.5% vs 13.0%).⁴ Survival is directly related to how far melanoma has spread, so early diagnosis is critical.

One study from 2021 assessed melanoma thickness, the most important melanoma prognostic factor, in veterans.⁵ Importantly, mortality has been shown to increase by 1.6-fold for every millimeter increase in thickness.⁵ The thicker the melanoma is, the higher the stage, which makes the melanoma more dangerous because it is more likely to spread. For this reason, early diagnosis and monitoring are important. Risk factors for thick melanoma (≥2 mm) versus thin melanoma (<2 mm) at diagnosis, including timing of prior dermatology visits, were evaluated in the study using data in the VACR.⁶ The results showed that veterans with thick melanoma were more likely to be older and be less likely to have dermatology visits less than or equal to two years after diagnosis.⁶

The previously mentioned study also investigated survival in patients with melanoma. That study compared results from the VACR and the SEER databases. According to the results, 5-year melanoma specific survival was lower across all ages of patients in the VACR compared to patients in the SEER program except in patients diagnosed at ≥80 years.⁴

“Veterans are more likely to present with advanced melanoma at diagnosis, highlighting the critical importance of early detection.”

Treatments for Melanoma

Treatment for melanoma mostly depends on stage—how early the disease was diagnosed and whether the melanoma has spread—and the location of the cancer. Surgery is the first treatment step for the majority of patients with melanoma, and it is often the only treatment necessary. In addition to surgery, and depending on the stage, treatment can include targeted therapies, immunotherapies, and clinical trials. For some patients, radiation and vaccines are an option.⁷

The treatment landscape for melanoma has changed over the last decade, especially for Stage III and Stage IV disease. In 2010, the options for Stage III and IV melanoma were limited and mostly ineffective. Today there are treatment options that are very successful for patients, namely immunotherapies, and there are a number of treatments being studied in clinical trials. While stage of disease is an important consideration when determining treatment options, other factors can also be important, such as overall health, the type of melanoma, whether the melanoma has a gene mutation, and the goal of treatment.⁷

Successful treatment of melanoma in veterans may look different than for the general population. In an accompanying article in this newsletter, we discuss recent results with immune checkpoint inhibitors (ICIs).

Conclusions

Melanoma has been shown to occur more frequently in veterans compared to the general population due to challenges such as increased sun exposure and a lack of sun protection. Education on risks of sun exposure and prevention strategies may be particularly important for service members, whether deployed or not. Furthermore, melanoma in veterans has been found to be diagnosed at later stages than in the general population, which highlights the need to emphasize early detection in current service members and veterans. Results from some studies show an association with poorer prognosis and survival in comparison with the general population, which supports the need to understand these differences and help improve treatment outcomes. A number of treatment options are available for melanoma, based on stage and other considerations, and some recent studies include data specific for veterans.

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REFERENCES

1. Betancourt JA, Granados PS, Pacheco GJ, et al. Exploring health outcomes for US veterans compared to non-veterans from 2003 to 2019. Healthcare (Basel). 2021;9(5):604. 

2. Rezaei SJ, Kim J, Onyeka S, et al. Skin Cancer and Other Dermatologic Conditions Among US Veterans. JAMA Dermatol. 2024;160(10):1107-1111.

3. Riemenschneider K, Liu J, Powers JG. Skin cancer in the military: A systematic review of melanoma and nonmelanoma skin cancer incidence, prevention, and screening among active duty and veteran personnel. J Am Acad Dermatol. 2018;78(6):1185-1192.

4. Chang MS, La J, Trepanowski N, et al. Increased relative proportions of advanced melanoma among veterans: a comparative analysis with the Surveillance, Epidemiology, and End Results registry. J Am Acad Dermatol. 2022;87(1):72-79.

5. Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017;376(23):2211-2222. 

6. Hartman RI, La J, Chang MS, et al. Risk factors for thick melanoma among veterans: A cross-sectional study. J Am Acad Dermatol. 2021;84(6):1766-1769.

7. AIM at Melanoma. https://www.aimatmelanoma.org/how-melanoma-is-treated/  Accessed on October 21, 2025.