BACKGROUND: The rates for incidence and mortality from melanoma are continuing to rise, although long term survival experience for patients with in situ and localized melanomas is favorable. RESULTS: Excess mortality varied with age at diagnosis, sex, duration since diagnosis and tumor thickness. CONCLUSIONS: Compared to the general white population in the United States, patients with localized melanoma experience a mild increase in Excess Death Rates (EDRs) the first year following diagnosis. For 1-5 years following diagnosis the EDRs are markedly increased across all age groups and decline thereafter. At 15-20 years following diagnosis the EDRS are not elevated except among patients < 40 years of age at diagnosis. Patients with tumors > 1.5 mm thick have mild to moderate increases in EDR for the first year following diagnosis, and extremely high EDRs up to 5 years. There is no elevation in mortality ratios or EDR for patients diagnosed with in situ melanomas.