Twenty-one years of cutaneous melanoma: stage shift, anatomical patterns and diagnostic trends from a Southern European tertiary center.

Cutaneous melanoma incidence continues to rise worldwide, while advances in dermoscopic surveillance increasingly influence the stage at diagnosis. Long-term single-center analyses offer a unique perspective on how demographic shifts, tumor biology, and diagnostic intensity interact over time. We retrospectively analyzed 4062 consecutive patients with histologically confirmed cutaneous melanoma diagnosed between 2003 and 2024 at a tertiary dermatology center in Southern Italy. Demographic characteristics, anatomical site, and Breslow thickness were collected. Temporal trends were assessed using regression models and χ2 tests for trend. Melanoma diagnoses increased significantly over the study period ( P  < 0.0001), with a near three-fold rise between the first (2003-2013) and second (2014-2024) decades. In parallel, the proportion of melanoma in situ increased from 38.2 to 57.5% ( P  < 0.0001), indicating a pronounced shift toward earlier-stage detection. Mean age at diagnosis rose significantly over time ( P  < 0.001). Trunk melanomas predominated overall, particularly among men, whereas lower limb melanomas were more frequent among women ( P  < 0.001). Acral melanomas, although uncommon, showed the highest proportion of thick lesions (48.6%; ≥0.8 mm). Over two decades, melanoma diagnoses increased markedly alongside a substantial shift toward early stage disease. While these trends reflect improvements in surveillance and diagnostic sensitivity, the persistent burden of thick melanomas - particularly in acral locations and older patients - underscores unresolved diagnostic gaps.