Despite data indicating that melanoma is diagnosed more frequently in patients living with HIV (PLWH) than in the general US population and that HIV-infected patients with melanoma having higher rates of cancer-specific mortality, the mechanisms underlying these disparities remain unclear, and data are lacking that describe tumor pathology and non-mortality outcomes in this patient population. Investigators conducted a study to describe differences in tumor presentation and disease course among patients with melanoma with or without underlying HIV infection in the era of effective HIV therapy. By HIV status, certain melanoma pathology features differed, with a higher prevalence of elevated mitotic rate (78.9% vs 41.2%) and vertical growth phase (90% vs 55%) among participants with HIV. While the vast majority of patients underwent lesion excision, PLWH had more post-treatment complications (44.8% vs 24.0%). Among those who received systemic therapy after excision, 100% of PLWH had progressive disease, compared with 30% of those without HIV, and 66.7% of PLWH experienced events that interrupted systemic therapy, compared with 30% of those without HIV. However, overall survival rates were similar between PLWH (79.3%) and those without HIV (82.8%).