Evidence concerning the accusation that melanoma is overdiagnosed - 02/07/21

Doi : 10.1016/j.jaad.2021.06.010

Sonal Muzumdar, BS ^a, Gloria Lin, MD, MS ^a, Philip Kerr, MD ^a, Jane M. Grant-Kels, MD ^a,^b,^⁎
^a Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
^b University of Florida Dermatology Department, Gainesville, Florida

^∗Correspondence to: Jane M. Grant-Kels, MD, Department of Dermatology, University of Connecticut School of Medicine, 21 South Road, 2nd Floor, Farmington, CT 06032.Department of DermatologyUniversity of Connecticut School of Medicine21 South Road, 2nd FloorFarmingtonCT06032

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Abstract

Background

Melanoma is one of the most commonly diagnosed malignancies in the United States and is responsible for the majority of deaths from skin cancer.

Objective

Since the 1970s, the incidence of melanoma has risen appreciably while melanoma-specific mortality has remained stable. This has raised a debate about potential overdiagnosis of melanoma. Herein, we review temporal trends in melanoma incidence and mortality and explore factors that may contribute to observed trends, including an aging population in the United States, ultraviolet exposure, increased numbers of biopsies by dermatologists and physician extenders, skin cancer screenings, histopathology criteria, and historic underdiagnosis. Additionally, we discuss melanoma overdiagnosis and the extent to which it may contribute to current trends.

Methods

The literature was reviewed.

Results

Several factors may contribute to an increased incidence of melanoma, including an aging population, ultraviolet exposure, increased skin biopsies, skin cancer screenings, histopathologic criteria, historic underdiagnosis, and current overdiagnosis.

Limitations

Further studies are required to determine exactly which tumors are being overdiagnosed, and how to improve patient outcomes with adjustment to physician's practice.

Conclusion

The rise in the incidence of melanoma observed since the 1970s is likely multifactorial.

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Key words : aging, biopsies, histopathology, melanoma, melanoma pandemic, overdiagnosis, public health, skin cancer screenings, ultraviolet exposure

Abbreviations used : CI, MIS, OR, UV