Analysis of Treatment Patterns for Mucosal Melanoma Using Real-World Data in the SEER-Medicare-Linked Database

Mucosal melanoma (MM) is a rare, aggressive disease, often diagnosed late, and associated with poor survival. Surgical resection is the main potential curative option, but anatomical complexity limits feasibility, and real-world evidence on treatment patterns remains scarce. This study aimed to describe treatment patterns across lines of therapy among patients diagnosed with MM in the US Surveillance, Epidemiology, and End Results Program (SEER)-Medicare-linked population.

A retrospective analysis was conducted using SEER-Medicare-linked data from January 2014 through December 2021, with follow-up through December 2023. Patients aged ≥ 65 years with MM were identified using SEER histology and International Classification of Diseases for Oncology, Third Edition (ICD-O-3) topography codes. Treatment patterns were evaluated by categorizing patients into surgical and nonsurgical cohorts and assessing systemic therapy use across lines of treatment. Descriptive statistics summarized patient demographics, tumor characteristics, and treatment modalities.

Among 1362 MM patients (median age, 76 years; 57.6% female), 41.3% underwent surgery. Among surgical patients, 36.2% received adjuvant systemic therapy, with PD-1/PD-L1-based regimens accounting for 51.5% overall; use varied by primary site and stage, with higher uptake in rectal/anal and nasal cavity melanoma and in regional-stage disease. In the nonsurgical cohort, 63.3% received systemic therapy as first-line treatment, with higher use in rectal/anal melanoma and distant-stage disease. PD-1/PD-L1-based regimens predominated (66.6%), with monotherapy used in 55.5% and combination therapy more frequently selected in higher-risk subsites and advanced-stage disease.

Combination regimens were more common among patients who did not undergo surgery and in certain high-risk subsites, reflecting heterogeneity in treatment intensity across anatomical locations and stages. This pattern likely reflects more advanced or complex disease presentations in these groups, underscoring the need for intensified therapy despite the higher risk of toxicity.