Increasing melanoma diagnoses

October 21, 2005

Their findings contradict what most dermatologists, and the general public, believe to be true about melanoma.

Yet, even with rates of the disease doubling since 1986, some are questioning if dermatologists are fighting an actual epidemic of the disease, or if they are fueling an epidemic of diagnoses.

In a recent study published in The British Medical Journal, H. Gilbert Welch, M.D., and his colleagues analyzed melanoma's changing incidence and death rate over time. Their findings contradict what most dermatologists, and the general public, believe to be true about melanoma.

"If there was a true increase in the underlying incidence of the disease, then we'd expect to see not only more early disease, but more advanced disease and more death as a result of it."

Their study, according to Dr. Welch, was actually instigated by some dermatologists who suspected that the melanoma epidemic may be more apparent than real. Dr. Welch and two colleagues, Steven Woloshin, M.D., and Lisa M. Schwartz, Ph.D., contend that if there is a true environmental origin behind melanoma, the disease would be increased at all stages, similar to what is seen with other cancers that are caused by toxic substances.

"The relevant question is: are these early-screening campaigns working? We should be cautious when inviting everyone to be screened," Dr. Welch tells Dermatology Times. "The one thing that excessive screening has done is doubled the amount of people who are diagnosed with cancer."

Excess screenings or saving lives?

As Dr. Welch's results become public, dermatologists are concerned about possible confusion the study's findings may instigate among the lay public, as well as the medical profession.

"It's very premature to put out this data and imply that anyone should change (his or her) behavior," warns Philip Bailin, M.D., section head, dermatologic surgery and cutaneous oncology, Cleveland Clinic. "I would hate to see the whole effort of early screening and diagnoses go to waste. This has been proven to be the only approach that has reduced mortality in melanoma over the years."

Even though the researchers state that people who notice suspicious moles should be examined, they argue that the screenings overall are directed at healthy people who have no reason to undergo a skin check.

The study's authors reviewed data from patients aged 65 and older - an age range melanoma is not contained within. Dr. Bailin contends that - as a result of removing reasonably suspicious nevi - he and his colleagues are seeing many more early melanomas in much younger patients.

"There is no question that there is an increase in skin cancer due to the fact that we've changed the criteria for diagnosis and increased the awareness of the public," says Clay J. Cockerell, M.D., president of the American Academy of Dermatology.

"But, there is some truth to what the researchers are saying. There may be some overuse of biopsies for certain reasons. But, if a lesion may be cancer, dermatologists are more likely to take the biopsy than run the risk of missing a cancer," Dr. Cockerell, clinical professor of dermatology and pathology and director of the division of dermatopathology at the University of Texas Southwestern Medical Center, Dallas, says.