OBJECTIVES: To examine the economic burden and health care utilization of melanoma patients in the U.S. Medicare population.  METHODS: A retrospective database analysis was performed using U.S. national Medicare claims from 01JAN2008 to 31DEC2012. Melanoma patients were identified using International Classification of Disease 9^thRevision Clinical Modification (ICD-9-CM) diagnosis code 172.xx. The first diagnosis date was designated as the index date. A comparator group was created, consisting of patients with the same age, region, gender, index year, and matched baseline Charlson Comorbidity Index scores but without a melanoma diagnosis. A random index date was chosen for the comparator cohort to reduce selection bias. Patients were required to have continuous medical and pharmacy benefits 1 year pre- and post-index date. One-to-one propensity score matching (PSM) was performed to compare follow-up health care costs and utilizations between the cohorts, adjusting for demographic and clinical characteristics.  RESULTS: Eligible patients (N=12,762) were identified for the melanoma and comparison cohorts. After 1:1 PSM, a total of 8,015 patients were matched from each cohort and baseline characteristics were well-balanced. More melanoma patients had health care utilizations, including Medicare carrier (99.6% vs. 64.3%), Durable Medical Equipment (DME; 19.8% vs. 14.4%) and Home Health Agency (HHA; 6.7% vs. 4.1%) claims, outpatient visits (68.4% vs. 35.4%), inpatient (10.9% vs. 6.6%) and skilled nursing facility (SNF) stays (2.4% vs. 1.7%), but fewer melanoma patients had prescription clams (43.6% vs. 49.8%). Patients diagnosed with melanoma incurred higher expenditures, including carrier ($3,527 vs. $1,324), DME ($153 vs. $101), HHA ($325 vs. $203), outpatient ($8,816 vs. $3,151), inpatient ($1,725 vs. $1,154) and total health care costs ($15,692 vs. $6,990) (p<0.0001). Similar SNF, hospice and pharmacy claim costs were observed in both cohorts.  CONCLUSIONS: Patients diagnosed with melanoma had a higher burden of illness compared to the comparison cohort of non-melanoma patients.