Melanoma accounts for approximately 1.6% of all diagnosed cancers globally [1] and its incidence rate has been steadily increasing over the past 50 years [2], principally among fair-skinned populations. It is largely preventable with ultraviolet radiation exposure being the most common cause[3]. As such, risk factors include sun exposure, lighter skin colour [4] and geography [5].

Melanoma rates in Australia increased between 1982 and 2006 and have remained relatively steady since then, with a possible slight decline [6]. Despite the relative stability in the recent past, incidence in Australia and New Zealand remains the highest in the world in both males and females [7]. There are differences in rates among different populations and jurisdictions within Australia, with age standardized rates highest in Queensland (76.2 per 100,000) and lowest in South Australia (37.9 per 100,000) [8]. In Australia, overexposure to ultraviolet radiation (UVR) is the cause of around 95 per cent of melanoma skin cancers [9], [10]. The most likely explanation for the higher incidence rate in Queensland is because it has a more sub-tropical climate than either Victoria or South Australia, with the average maximum UV level in the very high to extreme range throughout spring and summer [11]. There are also differences in the burden of melanoma across the population. Melanoma carries the third highest cancer burden among adults aged 25–64, and males account for two thirds of the melanoma disability associated life-years (DALYs) [12]. Prevention efforts in Australia have been most effective for younger age groups as they have been better able to reduce their exposure earlier in their life course [13].

The majority of people with melanoma are diagnosed with stage I disease and have 5-year survival rates above 99%. However survival decreases with increasing stage - 74% for stage II, 61% for stage III and 26% for stage IV [14]. Relative survival also decreases with age and is lower among males [6].

Given the high melanoma incidence in Australia alongside high mortality with later stage disease, there is a need to investigate further the populations and locations most at risk, so as to optimise public health activities in areas where intervention is most needed and most likely to impact the health of individuals. In this paper, we present melanoma data trends from 1997 to 2016 from South Australia, Victoria, and Queensland, which together account for 53% of the Australian population. We present the trends over time, and relative survival rates accounting for demographic factors such as age, sex, area-based socio-economic status, and remoteness as well as Breslow thickness to investigate patient outcomes both within and between the three states.