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

Bell, Katy J.L.; Nijsten, Tamar

doi:10.1111/bjd.21750

Cited by 12 publications

(10 citation statements)

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“…Patients who are overdiagnosed can only be harmed—they cannot benefit, as there is nothing that needs to be fixed. These harms are physical, psychological and economic 40. Physical harms can include overtreatment, repeat skin biopsies, scarring, pain, infection and/or functional impairment.…”

Section: Discussionmentioning

confidence: 99%

Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method

Adamson,

Naik,

Jones

et al. 2024

BMJ EBM

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ObjectivesTo quantify the proportion of melanoma diagnoses (invasive and in situ) in the USA that might be overdiagnosed.DesignIn this ecological study, incidence and mortality data were collected from the Surveillance, Epidemiology and End Results 9 registries database. DevCan software was used to calculate the cumulative lifetime risk of being diagnosed with melanoma between 1975 and 2018, with adjustments made for changes in longevity and risk factors over the study period.SettingUSA.ParticipantsWhite American men and women (1975–2018).Main outcome measuresThe primary outcome was excess lifetime risk of melanoma diagnosis between 1976 and 2018 (adjusted for year 2018 competing mortality and changes in risk factors), which was inferred as likely overdiagnosis. The secondary outcome was an excess lifetime risk of melanoma diagnosis in each year between 1976 and 2018 (adjusted and unadjusted).ResultsBetween 1975 and 2018 the adjusted lifetime risk of being diagnosed with melanoma (invasive and in situ) increased from 3.2% (1 in 31) to 6.4% (1 in 16) among white men, and from 1.6% (1 in 63) to 4.5% (1 in 22) among white women. Over the same period, the adjusted lifetime risk of being diagnosed with melanoma in situ increased from 0.17% (1 in 588) to 2.7% (1 in 37) in white men and 0.08% (1 in 1250) to 2.0% (1 in 50) in white women. An estimated 49.7% of melanomas diagnosed in white men and 64.6% in white women were overdiagnosed in 2018. Among people diagnosed with melanomas in situ, 89.4% of white men and 85.4% of white women were likely overdiagnosed in 2018.ConclusionsMelanoma overdiagnosis among white Americans is significant and increasing over time with an estimated 44 000 overdiagnosed in men and 39 000 in women in 2018. A large proportion of overdiagnosed melanomas are in situ cancers, pointing to a potential focus for intervention.

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Section: Discussionmentioning

confidence: 99%

Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method

Adamson,

Naik,

Jones

et al. 2024

BMJ EBM

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“…Overdiagnosis, referring to the detection of a true melanoma that is slow-growing and would not cause symptoms in a patient’s lifetime, is recognised as a problem in the early detection of melanoma and a potential harm in population screening [ 4 , 5 , 45 ]. Overdiagnosis causes harm through the diagnosis itself leading to unnecessary treatment, tests and other healthcare utilisation such as long-term clinical surveillance and fear of recurrence [ 12 ]. This is relevant to melanoma screening in Australia due to the high incidence of in situ melanomas, thin invasive melanomas, and very common keratinocyte carcinomas (basal cell and squamous cell carcinomas) [ 8 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of skin checks are conducted by General Practitioners (GPs) in generalist practices or dedicated primary care skin cancer clinics [ 9 ], and they are also conducted by specialists in dermatology settings [ 11 ]. Melanoma overdiagnosis [ 5 ] is evidenced by the rising rate of in situ melanoma over time alongside minimal changes to mortality rates, and requires population-level interventions to minimise this harm [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants

Dunlop,

Keogh,

Smith

et al. 2023

PLoS ONE

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Introduction In Australia, opportunistic screening (occurring as skin checks) for the early detection of melanoma is common, and overdiagnosis is a recognised concern. Risk-tailored cancer screening is an approach to cancer control that aims to provide personalised screening tailored to individual risk. This study aimed to explore the views of key informants in Australia on the acceptability and appropriateness of risk-tailored organised screening for melanoma, and to identify barriers, facilitators and strategies to inform potential future implementation. Acceptability and appropriateness are crucial, as successful implementation will require a change of practice for clinicians and consumers. Methods This was a qualitative study using semi-structured interviews. Key informants were purposively selected to ensure expertise in melanoma early detection and screening, prioritising senior or executive perspectives. Consumers were expert representatives. Data were analysed deductively using the Tailored Implementation for Chronic Diseases (TICD) checklist. Results Thirty-six participants were interviewed (10 policy makers; 9 consumers; 10 health professionals; 7 researchers). Key informants perceived risk-tailored screening for melanoma to be acceptable and appropriate in principle. Barriers to implementation included lack of trial data, reluctance for low-risk groups to not screen, variable skill level in general practice, differing views on who to conduct screening tests, confusing public health messaging, and competing health costs. Key facilitators included the perceived opportunity to improve health equity and the potential cost-effectiveness of a risk-tailored screening approach. A range of implementation strategies were identified including strengthening the evidence for cost-effectiveness, engaging stakeholders, developing pathways for people at low risk, evaluating different risk assessment criteria and screening delivery models and targeted public messaging. Conclusion Key informants were supportive in principle of risk-tailored melanoma screening, highlighting important next steps. Considerations around risk assessment, policy and modelling the costs of current verses future approaches will help inform possible future implementation of risk-tailored population screening for melanoma.

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“…The incidence of cutaneous melanoma has risen significantly in recent years. The reasons behind this trend are incompletely understood, although overdiagnosis is likely to have a role [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Dermoscopy Use Leads to Earlier Cutaneous Melanoma Diagnosis in Terms of Invasiveness and Size? A Single-Center, Retrospective Experience

Nazzaro

Passoni

Pozzessere

et al. 2022

JCM

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Background: The incidence of cutaneous melanoma has risen in recent years. The aim of this study was to compare cutaneous melanomas diagnosed at the Dermatology Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, from 2006 to 2020 and between two specific biennia, i.e., 2006–2007 and 2019–2020. Methods: Retrospective chart review, with dermoscopic image collection, of cutaneous melanomas diagnosed at the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, from 1 January 2006 to 31 December 2020 Results: A statistically significant increase was shown in the proportions of in situ melanoma and melanoma measuring less than 6 mm, i.e., small-diameter melanoma (SDM), across the studied period (p < 0.001). Moreover, in the biennium 2006–2007, among 220 melanoma diagnoses, 6 were in situ (2.7%), as compared with 68 melanomas in situ out of a total of 236 (28.8%) melanomas diagnosed in the biennium 2019–2020. A statistically significant difference in the proportion of in situ melanoma between the two biennia was demonstrated (p < 0.001). Furthermore, during the first biennium, 27/220 (12.3%) SDM were identified, as compared with 61/236 (25.9%) in the last. A statistically significant difference was shown in the proportion of SDM between the two (p < 0.001). Conclusions: The percentage of in situ melanomas and those that can be detected at a diameter <6 mm has increased. The latter has been shown to be around one-third of excised lesions, thus undermining the practicality of the ABCD mnemonic. Dermoscopic criteria for SDM are needed to help further refine melanoma diagnosis.

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

Abstract: Linked Article: Whiteman et al. Br J Dermatol 2022; 187:515–522.

Cited by 12 publications

References 11 publications

Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method

Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method

Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants

Dermoscopy Use Leads to Earlier Cutaneous Melanoma Diagnosis in Terms of Invasiveness and Size? A Single-Center, Retrospective Experience

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