Background: This study compares the average stage of diagnosis for melanoma by insurance status and household income. This is the largest such study for melanoma to date. Methods: Using the National Cancer Database (NCDB) we examined 299,214 patients with melanoma between 2000 and 2009 at 1,408 hospitals. The relationship of average stage of diagnosis is compared across insurance types and by income for 293,438 patients. Results: The VAH patient population had the lowest average stage of diagnosis (0.89) with the Medicaid population exhibiting the highest (1.87, p<0.0001). The VAH was lower than Tricare which had an average diagnosis of 1.11 (p<0.0001), private insurance 1.20 (p<0.0001), Medicare 1.34 (p<0.0001), and uninsured 1.70 (p<0.0001). The lowest rate of stage IV was private insurance (3.31%), with Tricare at 3.67% (p<0.0001), VAH 4.46% (p<0.0001), Medicare 5.74% (p<0.01), uninsured 10.12% (p<0.0001), and the highest rate was among Medicaid (14.35%, p<0.0001). The highest income category (≥$49K) had the lowest average stage at diagnosis of 1.16 compared to $39K to $48K (1.28, p<0.0001), $33K to $38K (1.35, p<0.0001), $28K to $32K (1.40, p<0.0001), and the lowest income group (<$28K) had the highest average stage of diagnosis (1.46, p<0.0001). The rate of Stage IV diagnosis increased from the highest income group (3.68%), followed by $39K to $48K (4.69%, p<0.0001), $33K to $38K (5.17%, p<0.0001), $28K to $32K (5.89%, p<0.0001), and less than $28K (6.92%, p<0.0001). Conclusions: Overall, VAH patients, higher income patients and patients with private insurance were diagnosed with earlier stage melanoma as compared to those with no insurance and Medicaid, who were more frequently diagnosed with stage IV disease. The VAH provision of high quality care, particularly preventative care, can result in improved patient outcomes such as cancer survival (Landrum et al, 2012). Reference: Landrum MB, Keating NL, Lamont EB, et al. Survival of Older Patients with Cancer in the Veterans Health Administration versus Fee-for-Service Medicare. Journal of Clinical Oncology, April 2012, 30(10): 1072-1079.