IMPORTANCE Melanoma is one of the most common cancers worldwide, typically diagnosed in older adults. There is an increasing incidence in the younger population (age Յ40 years) in America. In addition, approximately 1 in 5 cases of melanoma affect the head and neck. However, there are limited data on the incidence of head and neck melanoma in the pediatric, adolescent, and young adult population in North America (United States and Canada).OBJECTIVE To assess 20-year demographic and incidence changes associated with head and neck melanoma in the pediatric, adolescent, and young adult population in North America. DESIGN, SETTING, AND PARTICIPANTSA descriptive analysis of retrospective data on head and neck melanoma from the North American Association of Central Cancer Registries' Cancer in North America public use data set from 1995 to 2014 was conducted. The data set currently includes 93% of the United States and 64% of the Canadian populations. Eligible data were from 12 462 pediatric, adolescent, and young adult patients (aged 0-39 years) with a confirmed diagnosis of melanoma (International Classification of Diseases-Oncology 3 histologic types 8720-8790) in primary head and neck sites: skin of lip, not otherwise specified (C44.0); eyelid (C44.1); external ear (C44.2); skin of other/unspecified parts of face (C44.3); and skin of scalp and neck (C44.4). The study was conducted from January 26 to July 21, 2019. MAIN OUTCOMES AND MEASURESLog-linear regression was used to estimate annual percentage change in age-adjusted incidence rates (AAIRs) of head and neck melanoma. RESULTSOf the 12 462 patients with head and neck melanoma included in the study, 6810 were male (54.6%). The AAIR was 0.51 per 100 000 persons (95% CI, 0.50-0.52 per 100 000 persons). In North America, the incidence of head and neck melanoma increased by 51.1% from 1995 to 2014. The rate was higher in the United States (AAIR, 0.52; 95% CI, 0.51-0.53 per 100 000 person-years) than Canada (AAIR, 0.43; 95% CI, 0.40-0.45 per 100 000 persons). In the United States, the incidence increased 4.68% yearly from 1995 to 2000 and 1.15% yearly from 2000 to 2014. In Canada, the incidence increased 2.18% yearly from 1995 to 2014. Male sex (AAIR, 0.55; 95% CI, 0.54-0.57 per 100 000 persons), older age (AAIR, 0.79; 95% CI, 0.79-0.80 per 100 000 persons), and non-Hispanic white race/ethnicity (AAIR, 0.79; 95% CI, 0.77-0.80 per 100 000 persons) were associated with an increased incidence of head and neck melanoma. CONCLUSIONS AND RELEVANCEThe incidence of pediatric, adolescent, and young adult head and neck melanoma in North America appears to have increased by 51.1% in the past 2 decades, with males aged 15 to 39 years the main cohort associated with the increase.

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Objective: The last three decades in the United States have seen oropharyngeal cancer emerge as an important human papillomavirus (HPV)-associated cancer, with about three-quarters of cases thought to be positive for HPV. It has dramatically increased in incidence and recently surpassed cervical cancer as the leading HPV-associated cancer. While positive HPV tumor status generally portends better survival probability compared with non-HPV related head and neck cancer, there is a paucity of data describing mortality trends. This study aimed to describe trends in oropharyngeal cancer incidence-based mortality in the United States in the last three decades. Methods: We estimated age-adjusted incidence-based mortality rates (AAMR) from first primary oropharyngeal squamous cell carcinoma (OPSCC), using the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1985-2016. To prevent later years from having a cumulatively larger set of patients diagnosed in the past, we only included OPSCC patients who died within 10 years of diagnosis. AAMRs were stratified by race, sex, and age at death and were presented per 100,000 person-years. Rate ratios (RRs) determined which groups had significantly different AAMRs, and Joinpoint regression calculated which groups had significant increases/decreases in annual AAMRs over time through annual percentage changes (APCs) and average APCs (AAPCs). We used 95% confidence intervals (CIs) to determine significant RRs, APCs, and AAPCs. Results: This study included 12,102 patients who died from first primary OPSCC from 1985-2016 with an AAMR of 1.16 per 100,000 person-years. AAMRs among males were 3.58 times higher than for females (RR = 3.58, 95% CI 3.43, 3.73). AAMRs among blacks were about 2 times higher than for whites (RR = 2.06, 95% CI 1.96, 2.16) but were about 60% lower for other race than whites (RR = 0.37, 95% CI 0.34, 0.42). From 1985-2009, AAMRs for first primary OPSCC decreased approximately 1.92% annually (APC = -1.92, 95% CI -2.27, -1.56) but remained stable from 2009-2016, which resulted in an average annual decrease of -1.31% from 1985-2016 (AAPC = -1.31, 95% CI -1.84, -0.78). When stratified by race or sex, all groups exhibited significant mortality rates decrease, however decrease was significantly greater among whites than blacks (white AAPC1985-2016 = -0.76; 95% CI -1.33, -0.17 vs black AAPC1985-2016 = -3.36; 95% CI -3.85, -2.87). AAMRs significantly decreased among 65+ year olds (AAPC = -0.88, 95% CI -1.63, -0.13), while AAMRs for 15-39 and 40-64-year olds exhibited non-significant decreases. Conclusions: While there has been significant decrease in oropharyngeal cancer mortality in the last three decades in the United States across age groups, races/ethnicity, and gender, there remained a significant mortality gap between blacks and whites, highlighting the persistent cancer-related disparity in the United States. Citation Format: Nosayaba Osazuwa-Peters, Matthew C Simpson, Sean T Massa, Eric Adjei Boakye, Kara M Christopher, Sai D Challapalli, Katherine M Polednik, Haley N Bray, Greg M Ward, Mark A Varvares. Oropharyngeal cancer incidence-based mortality trends in the United States, 1985-2016 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D128.

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