Do we need to rethink the diagnoses melanoma in situ and severely dysplastic naevus?

Abstract

DEAR EDITOR, Many countries have seen a dramatic increase in the reported incidence of cutaneous melanoma in recent decades, largely driven by increased diagnoses of melanoma in situ and thin invasive melanoma. The incidences of thick and metastatic melanomas, and melanoma mortality have remained relatively stable. While ageing populations could be Table 1 Evidence identified to support or reject a change to diagnostic thresholds and/or terminology used for melanoma in situ (MIS) and severely dysplastic naevus (SDN) Natural history studies: observation of MIS or SDN not actively treated or incompletely excised (partial or close margins) for ≥6 months. The collective 127 cases are underlined Study Country Study design Key findings Overall risk of bias Engeln, 2017 USA Retrospective chart review 286 people with SDN (140 with negative margins, 47 with close margins, 40 with positive margins, 3 with indeterminate margins, 56 margins not reported) observed for ≥5 years. 0 cases of invasive melanoma at same site, metastasis, or deaths from melanoma High

Histopathologic reassessment of melanoma and other melanocytic skin lesions excised in 2009 and 2018–2019

“…Mye tyder på at slike lesjoner snarere bør betraktes som risikofaktorer for melanom enn som forstadier til melanom (23). Det er imidlertid forbedre indikasjonsstillingen for eksisjon av pigmenterte hudlesjoner (24,25).…”

A review of nevus‐associated melanoma: What is the evidence?

“…5 This controversy is, in part, due to their overall low rate of transformation to melanoma and scarce data on the natural history of progression. 6 Another matter of debate regarded the possibility that the reported differences in NAM vs. de novo melanoma were due to an underestimation of NAM in thicker lesions due to obliteration of the nevus component. During the last few years, several evidence has accumulated in order to address these controversies.…”

“…Nevus‐associated melanoma and the concept of acquired melanocytic nevi serving as precursors of melanoma has long been considered as a controversial topic 5 . This controversy is, in part, due to their overall low rate of transformation to melanoma and scarce data on the natural history of progression 6 . Another matter of debate regarded the possibility that the reported differences in NAM vs. de novo melanoma were due to an underestimation of NAM in thicker lesions due to obliteration of the nevus component.…”

Melanoma overdiagnosis: why it matters and what can be done about it

“…1 Biomarkers can potentially help us with the prediction of the cause of a disease, its progression, regression, outcome, diagnosis and, in the case of the scoping review in this issue of the BJD, 2 the results of treatment. However, the sheer volume of the biomarker literature is in stark contrast to the few biomarkers that have established utility in clinical practice, 3 especially in inflammatory disease.…”

“…Overdiagnosis occurs when a person is diagnosed with melanoma but they would never have experienced symptoms or harm from that lesion had it been left undetected and untreated 2,3 . It causes harm through the melanoma diagnosis itself, 4 and by leading to unnecessary treatment, tests and other healthcare such as long‐term clinical surveillance 5 .…”