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The Melanoma Epidemic: More Apparent Than Real?

      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.
      LLNL (Lawrence Livermore National Laboratory)
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      REFERENCES

        • Burton RC
        • Armstrong BK
        Current melanoma epidemic: a nonmetastasizing form of melanoma?.
        World J Surg. 1995; 19: 330-333
        • Burton RC
        Analysis of public education and the implications with regard to nonprogressive thin melanomas.
        Curr Opin Oncol. 1995; 7: 170-174
        • MacLennan R
        • Green AC
        • McLeod GR
        • Martin NG
        Increasing incidence of cutaneous melanoma in Queensland, Australia.
        J Nati Cancer Inst. 1992; 84: 1427-1432
        • Brown L
        • Palmer PH
        Melanoma incidence in Tauranga 1980-9.
        NZMedJ. 1991; 104: 109-111
        • Chen YT
        • Zheng T
        • Holford TR
        • Berwick M
        • Dubrow R
        Malignant melanoma incidence in Connecticut (United States): time trends and age-period-cohort modeling by anatomic site.
        Cancer Causes Control. 1994; 5: 341-350
        • Rigel DS
        • Kopf AW
        • Friedman RJ
        The rate of malignant melanoma in the United States: are we making an impact?.
        J Am Acad Dermatol. 1987; 17: 1050-1053
        • MacKie R
        • Hunter JA
        • Aitchison TC
        • Hole D
        • Melaren K
        • Rankin R
        • et al.
        Cutaneous malignant melanoma, Scotland, 1979-89. The Scottish Melanoma Group.
        Lancet. 1992; 339: 971-975
        • Elwood JM
        • Koh HK
        Etiology, epidemiology, risk factors, and public health issues of melanoma.
        Curr Opin Oncol. 1994; 6: 179-187
        • Thorn M
        • Ponten F
        • Bergstrom R
        • Sparen P
        • Adami HO
        Trends in tumour characteristics and survival of malignant melanoma 1960-84: a population-based study in Sweden.
        Br J Cancer. 1994; 70: 743-748
        • Centers for Disease Control and Prevention
        Deaths from melanoma-United States, 1973-1992.
        MMWRMorb Mortal Wkly Rep. 1995; 44 (337): 343-347
        • Osterlind A
        Epidemiology on malignant melanoma in Europe.
        Acta Oncol. 1992; 31: 903-908
        • Burton RC
        • Armstrong BK
        Recent incidence trends imply a nonmetastasizing form of invasive melanoma.
        Melanoma Res. 1994; 4: 107-113
        • Burton RC
        • Coates MS
        • Hersey P
        • Roberts G
        • Chetty MP
        • Chen S
        • et al.
        An analysis of a melanoma epidemic.
        Int J Cancer. 1993; 55: 765-770
        • Koh HK
        • Lew RA
        • Prout MN
        Screening for melanoma/skin cancer: theoretic and practical considerations.
        J Am Acad Dermatol. 1989; 20: 159-172
        • Rigel DS
        • Friedman RJ
        • Kopf AW
        • Weltman R
        • Prioleau PG
        • Safai B
        • et al.
        Importance of complete cutaneous examination for the detection of malignant melanoma.
        J Am Acad Dermatol. 1986; 14: 857-860
        • Friedman RJ
        • Rigel DS
        • Kopf AW
        Early detection of malignant melanoma: the role of physician examination and self-examination of the skin.
        CA Cancer J Clin. 1985; 35: 130-151
        • Kopf AW
        • Rigel DS
        • Friedman RJ
        The rising incidence and mortality rate of malignant melanoma.
        J Dermatol Surg Oncol. 1982; 8: 760-761
        • Koh HK
        • Geller AC
        • Miller DR
        • Lew RA
        Can screening for melanoma and skin cancer save lives?.
        Dermatol Clin. 1991; 9: 795-803
        • Girgis A
        • Campbell EM
        • Redman S
        • Sanson-Fisher RW
        Screening for melanoma: a community survey of prevalence and predictors.
        MedJAust. 1991; 154: 338-343
      1. American Academy of Dermatology. Melanoma can be cured, but most people don't know the signs [press release]. 1995 May 1

        • Koh HK
        • Miller DR
        • Geller AC
        • Clapp RW
        • Mercer MB
        • Lew RA
        Who discovers melanoma? Patterns from a population-based survey.
        J Am Acad Dermatol. 1992; 26: 914-919
        • Bulliard JL
        • Raymond L
        • Levi F
        • Schüler G
        • Enderlin F
        • Pellaux S
        • et al.
        Prevention of cutaneous melanoma: an epidemiological evaluation of the Swiss campaign.
        Rev Epidemiol Sante Publique. 1992; 40: 431-438
        • Hiatt RA
        • Fireman B
        The possible effect of increased surveillance on the incidence of malignant melanoma.
        Prev Med. 1986; 15: 652-660
        • Gong G
        • Whittemore AS
        • West D
        • Moore II, DH
        Cutaneous melanoma at Lawrence Livermore National Laboratory: comparison with rates in two San Francisco bay area counties.
        Cancer Causes Control. 1992; 3: 191-197
        • Hoffmann K
        • Dirschka T
        • Schatz H
        • Segerling M
        • Tiemann T
        • Hoffmann A
        • et al.
        A local education campaign on early diagnosis of malignant melanoma.
        Eur J Epidemiol. 1993; 9: 591-598
        • MacKie RM
        • Hole D
        Audit of public education campaign to encourage earlier detection of malignant melanoma.
        BMJ. 1992; 304: 1012-1015
        • Elwood JM
        Screening in the control of melanoma [editorial].
        MedJAust. 1991; 155: 654-656
        • Salopek TG
        • Marghoob AA
        • Slade JM
        • Rao B
        • Rigel DS
        • Kopf AW
        • et al.
        An estimate of the incidence of malignant melanoma in the United States. Based on a survey of members of the American Academy of Dermatology.
        Dermatol Surg. 1995; 21: 301-305
        • Farmer ER
        • Gonin R
        • Hanna MP
        Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists.
        Hum Pathol. 1996; 27: 528-531
        • Ackerman AB
        Discordance among expert pathologists in diagnosis of melanocytic neoplasms [editorial].
        Hum Pathol. 1996; 27: 1115-1116
        • van der Esch EP
        • Muir CS
        • Nectoux J
        • Macfarlane G
        • Maisonneuve P
        • Bharucha H
        • et al.
        Temporal change in diagnostic criteria as a cause of the increase of malignant melanoma over time is unlikely.
        Int J Cancer. 1991; 47: 483-490
        • Koh HK
        • Geller AC
        • Miller DR
        • Caruso A
        • Gage I
        • Lew RA
        Who is being screened for melanoma/skin cancer? Characteristics of persons screened in Massachusetts.
        J Am Acad Dermatol. 1991; 24: 271-277
        • Black WC
        • Welch HG
        Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy.
        N Engl J Med. 1993; 328: 1237-1243
        • Harach HR
        • Franssila KO
        • Wasenius VM
        Occult papillary carcinoma of the thyroid: a “normal” finding in Finland; a systematic autopsy study.
        Cancer. 1985; 56: 531-538
        • Potosky AL
        • Miller BA
        • Albertsen PC
        • Kramer BS
        The role of increasing detection in the rising incidence of prostate cancer.
        JAMA. 1995; 273: 548-552
        • Russell LB
        Educated Guesses: Making Policy About Medical Screening Tests. University of California Press, Berkeley (CA)1994
        • Yamamoto K
        • Hayashi Y
        • Hanada R
        • Kikuchi A
        • Ichikawa M
        • Tanimura M
        • et al.
        Mass screening and age-specific incidence of neuroblastoma in Saitama Prefecture, Japan.
        J Clin Oncol. 1995; 13: 2033-2038
        • Feuer EJ
        • Wun LM
        How much of the recent rise in breast cancer incidence can be explained by increases in mammography utilization? A dynamic population model approach.
        Am J Epidemiol. 1992; 136: 1423-1436
        • Kerlikowske K
        • Grady D
        • Rubin SM
        • Sandrock C
        • Ernster VL
        Efficacy of screening mammography. A meta-analysis.
        JAMA. 1995; 273: 149-154
        • Boland CR
        • Sato J
        • Appelman HD
        • Bresalier RS
        • Feinberg AP
        Microallelotyping defines the sequence and tempo of allelic losses at tumour suppressor gene loci during colorectal cancer progression.
        Nature Med. 1995; 1: 902-909