The ‘epidemic’ of melanoma between under‐ and overdiagnosis

Abstract

In the past decades, the incidence of melanoma has been reported to rise in epidemic proportions. The chief reason for that pseudo-epidemic is improved criteria for diagnosis that allow melanomas to be recognized far more accurately and at earlier stages. The rising number of melanomas diagnosed has resulted in increased diagnostic scrutiny, more pigmented lesions being biopsied and more melanomas recognized, thus enhancing the 'epidemic' in self-perpetuating fashion. Regression of melanomas may, in part, explain why lesions undetected before did not result in a far higher mortality. Another potential reason for the disparity between increasing incidence of melanoma and relatively steady mortality may be overdiagnosis of melanoma. The latter may be curtailed by establishment of well-defined diagnostic categories, efforts to establish reliable criteria for recognition of those categories, better clinicopathologic correlation, postponement of biopsy of pigmented lesions in the case of irritation and excisional rather than incisional biopsies.

Incidence and survival in patients with cutaneous melanoma by morphology, anatomical site and TNM stage: A Danish Population-based Register Study 1989–2011

“…a diagnostic drift where cases previously classified as benign melanocytic naevi are diagnosed as malignant early-stage melanoma [15][16][17][18][19][20][21]34]. This explanation is supported by the inconsistency between the growth in incidence of melanoma and the nearly stable mortality from skin melanoma.…”

“…It has therefore been questioned whether this apparent trend represents a true increase in risk [15,20]. Awareness and better detection and identification of early-stage melanoma could have contributed to the perceived rising incidence, and therefore the recent trends in melanoma incidence have been called a pseudo-epidemic due to earlier and more accurate diagnosis of earlier-stage melanomas [21].…”

“…Meanwhile, the increasing incidence trend contrasts with stable melanoma mortality, and it has therefore been questioned whether the recent incidence increase represents a true increase in risk, or whether it is due to better detection, greater awareness, and potential overdiagnosis [15][16][17][18][19][20][21].…”

MDA5 autoantibody—another indicator of clinical diversity in dermatomyositis

“…Some argue that the marked increase in the incidence of malignant melanoma in the USA over the past 20 years has been due largely to over diagnosis resulting from changes in skin biopsy indication and interpretation of skin biopsy findings (12)(13)(14)(15). Similar arguments have led the United States Preventive Services Task Force (USPSTF) in 2012 to no longer recommend prostate cancer screening by prostate-specific antigen (PSA) blood testing (14,16,17).…”

Incidence of Childhood and Adolescent Melanoma in the United States: 1973–2009

“…Increased incidence trends in adults have been characterized as the result of overdiagnosis after changes in diagnostic criteria in the 1970s and subjective interpretation when distinguishing melanoma from benign nevi. [61][62][63] It is currently unclear whether misclassification of benign nevi as malignant melanoma in SEER has increased over time or contributes to the rising incidence of adolescent melanoma. We also acknowledge the complexity of differential diagnosing melanocytic lesions in young children, especially on the face.…”