AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Approach to Melanoma Diagnosis

Description

The presentation discusses the complexities and challenges surrounding melanoma diagnosis, highlighting the historical push for early detection and the role of dermatoscopes in diagnosing melanomas more accurately. Although advancements in early diagnosis have been made, critics argue that the increased incidence of diagnosed early-stage melanoma does not correspond with a rise in mortality, suggesting issues of overdiagnosis. This phenomenon is chiefly attributed to heightened awareness among clinicians and patients, which leads to increased biopsies of benign lesions that could be misclassified as cancerous. The speaker illustrates how the subjective nature of histopathological diagnosis contributes to inaccurate results, with significant discrepancies among pathologists in diagnosing various melanocytic lesions. Furthermore, studies suggest that many early-stage melanomas may not progress to lethal forms, indicating overdiagnosis and unnecessary treatment. Recommendations include reevaluating screening practices to prevent the escalation of overdiagnosis, emphasizing the need for education among pathologists about the implications of their diagnoses. Overall, there's a call for a shift in how melanomas are diagnosed, suggesting that current strategies may unintentionally cause more harm than benefit, particularly among low-risk populations.

View more

Conclusions

  • Melanoma detection efforts have been successful, but the stability in mortality rates suggests a paradox of overdiagnosis.
  • With successful early detection of melanomas, localized cases have increased without corresponding rises in mortality, indicating potential overdiagnosis.
  • Overdiagnosis leads to unnecessary procedures and misdiagnosis in the realm of melanoma, particularly in thin or in-situ lesions.
  • The majority of melanomas diagnosed may not present a lethal threat, particularly those classified as melanoma in-situ.
  • Histopathologic diagnoses are unreliable, leading to significant discord among pathologists regarding melanoma identification.
  • The current landscape of melanoma diagnosis is influenced by heightened awareness and fear of missing true cases, which contributes to overdiagnosis.
  • There is a growing consensus that many dysplastic nevi are not precursors to melanoma but markers of increased risk.
  • Epidemiological data suggest that a large proportion of melanoma cases are overdiagnosed, which affects treatment approaches and patient anxiety.
  • The practice of population-based skin cancer screening remains controversial due to insufficient evidence of its benefits in reducing mortality.
  • Ackerman AB. Macular and patch lesions of malignant melanoma: malignant melanoma in situ. J Dermatol Surg Oncol 1983;9:615-8.
  • Kittler H et al. Diagnostic accuracy of dermoscopy. Lancet Oncol 2002.
  • Megaris A, Lallas A, Bagolini LP, et al. Dermoscopy features of melanomas with a diameter up to 5 mm (micromelanomas): A retrospective study. J Am Acad Dermatol. 2020;83(4):1160-1161.
  • Welch HG, Robertson DJ. Colorectal Cancer on the Decline - Why Screening Can't Explain It All. The New England Journal of Medicine. 2016;374(17):1605-1607.
  • Croswell JM, Ransohoff DF, Kramer BS. Principles of cancer screening: lessons from history and study design issues. Semin Oncol. 2010;37(3):202-215.
  • Brodersen J, Schwartz LM, Heneghan C, O'Sullivan JW, Aronson JK, Woloshin S. Overdiagnosis: what it is and what it isn't. BMJ Evid Based Med. 2018;23(1):1-3.
  • Robra BP. (2021) Harms and Benefits of Cancer Screening. In: Bauer A.W ., Hofheinz RD ., Utikal J.S. (eds) Ethical Challenges in Cancer Diagnosis and Therapy. Recent Results in Cancer Research, vol 218. Springer, Cham. https://doi.org/10.1007/978-3-030-63749-1_7
  • Joann G Elmore, Raymond L Barnhill, David E Elder, et al. Pathologists' diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study. BMJ. 2017;357:j2813.
  • Duffy K, Grossman D. The dysplastic nevus: from historical perspective to management in the modern era: part II. Molecular aspects and clinical management. J Am Acad Dermatol. 2012;67(1):19.e1-32. doi:10.1016/j.jaad.2012.03.013.
  • Saida T, Koga H. Dermoscopic patterns of acral melanocytic nevi: their variations, changes, and significance. Arch Dermatol. 2007;143(11):1423-6.