Epidemiologic characteristics of melanoma in older adolescents and young adult (AYA) patients aged 15 to 39 years are unknown. We examined the epidemiologic characteristics of melanoma in AYA patients and then extracted demographic and pathologic data for this retrospective cohort study from the Surveillance, Epidemiology, and End Results database (2000-2019). Cox regression analyses were used to assess the risk of all-cause death, cancer-specific death, and second primary malignancy. A total of 2,835 AYA patients with melanoma were included, of whom 926 (32.66%) had a second primary malignancy. The incidence of melanoma in AYA patients decreased from 0.9 per 1,000,000 person-year in 2000 to 0.2 per 1,000,000 person-year in 2019, with an average annual percentage change of -6.3% (95% CI, -7.2% to -5.3%). Melanoma patients who were darker skinned (Black) (hazard ratio, 3.794
95% CI, 1.382-10.412) were associated with an increased risk of second primary malignancies, whereas patients with a Breslow depth of >
4 mm (hazard ratio, 0.517
95% CI, 0.379-0.706), melanoma site on the trunk (hazard ratio, 0.700
95% CI, 0.536-0.915), and extremities (hazard ratio, 0.760
95% CI, 0.585-0.988) were associated with a decreased risk of second primary malignancies. This study may provide statistical data on the epidemiologic characteristics of melanoma in AYA patients.