To examine inconsistencies between the growth in incidence of melanoma and more modest
changes in melanoma-related mortality, we reviewed the medical literature on the incidence
of melanoma diagnosis and associated mortality and on the changes in diagnosis and
mortality over time. Increases in melanoma surveillance activity have been associated
with increases in the diagnosis of thin melanomas, but the incidence of advanced tumors
has changed minimally. The large increases in diagnosis of melanoma without commensurate
increases in advanced tumors and mortality are not compatible with presumed malignant
behavior of thin melanomas. Increased intensity of melanoma surveillance may artificially
increase the incidence of melanoma by harvesting histologically “malignant” but biologically
benign tumors. Little available evidence suggests the presence of an actual increase
in the frequency of biologically malignant tumors. Attempts to increase screening
intensity for melanoma may result in further increases in diagnosis of melanomas.
Nevertheless, limitations in histopathologic diagnostic techniques will continue to
hinder efforts at early identification of those at risk for death from melanoma without
diagnosing melanoma in large numbers of patients with biologically benign pigmented
skin tumors.
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© 1997 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
