The Hawaii Tumor Registry (HTR) is an active surveillance monitoring system for the entire state of Hawaii consisting of 8 major and 124 minor islands, covering 1, 367 miles from tip to tip. The resident population is over one million people with around 150, 000 visiting each day. The HTR was established in 1960 and became a National Cancer Institute/Surveillance, Epidemiology and End Results (NCI/SEER) program in 1973. It collects the required SEER demographic and diagnostic items for all malignant melanoma