Melanoma Overdiagnosis Rising Among White Patients

Марина Десятниченко/AdobeStock

Overdiagnosis of melanoma among white adults in the US has increased dramatically in the past 40 years, according to a study released today by the journal BMJ Evidence-Based Medicine.¹

The study authors point to a concerning pattern: While the incidence of melanoma has increased dramatically in the US—rising from 8.3 per 100,000 in 1975 to 49.1 per 100,000 in 2016—mortality has remained flat over the same period.

This points to overdiagnosis, said Adewole Adamson, MD, MPP, lead author of the study.

He told Dermatology Times, “Improvement in treatment for advanced melanoma did not happen until 2011, and the effects of treatment on mortality across the population were not seen until 2014 in the US. So, across much of the past 40 years, melanoma rates have been climbing and it had no effect on the death rates, concerning for overdiagnosis.”

Adamson et al define melanoma overdiagnosis as “the diagnosis of cancers that meet the pathological definition for cancer but are not destined to cause harm—even if left untreated.”

“When we screen for cancers,” Adamson told Dermatology Times when discussing previous research, “we end up finding a lot of things we call cancer that, if we didn’t go looking for, would not have harmed the patient at all.”²

Diagnosing people with cancers that would never have harmed them has implications for future surveillance efforts and healthcare-system costs, he added, not to mention patients’ physical, mental, and financial health.²

Findings Expand on Previous Research

Looking at data from 1975 to 2018, Adamson at al found the adjusted lifetime risk of being diagnosed with melanoma (invasive and in situ) increased from 3.2% to 6.4% among white men, and from 1.6% to 4.5% among white women.

Over the same period, the adjusted lifetime risk of being diagnosed with melanoma in situ increased from 0.17% to 2.7% in white men and 0.08% to 2.0% in white women, the study authors wrote.

In 2018, an estimated 49.7% of melanomas diagnosed in white men and 64.6% in white women were overdiagnosed, according to the findings.This amounted to about 83,000 cases.

Among people diagnosed with melanomas in situ, 89.4% of white men and 85.4% of white women were likely overdiagnosed in 2018.

Adamson et al determined in a 2022 study published in JAMA Dermatology that around 60% of melanomas in white men and women were overdiagnosed.²

This study “was limited by assumptions made using black Americans as an external standard for estimating overdiagnosis,” Adamson told Dermatology Times.

“Moreover, it is only one method to estimate overdiagnosis where multiple approaches are necessary to triangulate the approximate true extent of the problem. This current study also estimates proportion due to in situ vs invasive disease. The most important finding is that a vast majority of melanoma in situ is likely overdiagnosis.”

References

1. Adamson AS, Naik G, Jones MA, et al. Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method. BMJ Evidence-Based Medicine. Published Online First: 19 January 2024. doi:10.1136/bmjebm-2023-112460
2. Jesitus J. Study reports melanoma overdiagnosis in white patients. Dermatology Times. Accessed January 23, 2024. https://www.dermatologytimes.com/view/study-reports-melanoma-overdiagnosis-in-white-patients.