BACKGROUND: The reported incidence of melanoma has greatly increased and this has been attributed to ultraviolet exposure. OBJECTIVES: We considered the possibility that the increase was an artefact caused by diagnostic drift. METHODS: We tested this by analysing the histological diagnosis, mortality and incidence of all lesions reported as melanomas in East Anglia between 1991 and 2004. RESULTS: There were 3971 melanomas in all, and their annual incidence increased from 9.39 to 13.91 cases per 100,000 per year during the period studied. This increased incidence was almost entirely due to minimal, stage 1 disease. There was no change in the combined incidence of the other stages of the disease, and the overall mortality only increased from 2.16 to 2.54 cases per 100,000 per year. CONCLUSIONS: We therefore conclude that the large increase in reported incidence is likely to be due to diagnostic drift which classifies benign lesions as stage 1 melanoma. This conclusion could be confirmed by direct histological comparison of contemporary and past histological samples. The distribution of the lesions reported did not correspond to the sites of lesions caused by solar exposure. These findings should lead to a reconsideration of the treatment of 'early' lesions, a search for better diagnostic methods to distinguish them from truly malignant melanomas, re-evaluation of the role of ultraviolet radiation and recommendations for protection from it, as well as the need for a new direction in the search for the cause of melanoma.
BACKGROUND: The reported incidence of melanoma has greatly increased and this has been attributed to ultraviolet exposure. OBJECTIVES: We considered the possibility that the increase was an artefact caused by diagnostic drift. METHODS: We tested this by analysing the histological diagnosis, mortality and incidence of all lesions reported as melanomas in East Anglia between 1991 and 2004. RESULTS: There were 3971 melanomas in all, and their annual incidence increased from 9.39 to 13.91 cases per 100,000 per year during the period studied. This increased incidence was almost entirely due to minimal, stage 1 disease. There was no change in the combined incidence of the other stages of the disease, and the overall mortality only increased from 2.16 to 2.54 cases per 100,000 per year. CONCLUSIONS: We therefore conclude that the large increase in reported incidence is likely to be due to diagnostic drift which classifies benign lesions as stage 1 melanoma. This conclusion could be confirmed by direct histological comparison of contemporary and past histological samples. The distribution of the lesions reported did not correspond to the sites of lesions caused by solar exposure. These findings should lead to a reconsideration of the treatment of 'early' lesions, a search for better diagnostic methods to distinguish them from truly malignant melanomas, re-evaluation of the role of ultraviolet radiation and recommendations for protection from it, as well as the need for a new direction in the search for the cause of melanoma.
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Authors: Michael W Piepkorn; Raymond L Barnhill; David E Elder; Stevan R Knezevich; Patricia A Carney; Lisa M Reisch; Joann G Elmore Journal: J Am Acad Dermatol Date: 2013-10-28 Impact factor: 11.527
Authors: Wei-Yin Lim; Rachael L Morton; Robin M Turner; Marisa C Jenkins; Pascale Guitera; Les Irwig; Angela C Webster; Mbathio Dieng; Robyn P M Saw; Donald Low; Cynthia Low; Katy J L Bell Journal: JAMA Dermatol Date: 2018-04-01 Impact factor: 10.282
Authors: Jeffrey P North; John T Vetto; Rajmohan Murali; Kevin P White; Clifton R White; Boris C Bastian Journal: Am J Surg Pathol Date: 2011-08 Impact factor: 6.394
Authors: Laura J Esserman; Ian M Thompson; Brian Reid; Peter Nelson; David F Ransohoff; H Gilbert Welch; Shelley Hwang; Donald A Berry; Kenneth W Kinzler; William C Black; Mina Bissell; Howard Parnes; Sudhir Srivastava Journal: Lancet Oncol Date: 2014-05 Impact factor: 41.316
Authors: Annie Herbert; Minjoung M Koo; Matthew E Barclay; David C Greenberg; Gary A Abel; Nick J Levell; Georgios Lyratzopoulos Journal: Melanoma Res Date: 2020-06 Impact factor: 3.199