10.5826/dpc.1304a249
text/xml
2160-9381
3750
en
Ashfaq A.  Marghoob
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Melanoma Overdiagnosis: Historical Perspective and the Path Forward
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Kramer vs Kramer
2023-10-31
2023-08-07
2023-10-31
2024-01-16
e2023249
Dermatol Pract Concept
Ashfaq A.  Marghoob
2023/10/31
10.5826/dpc.1304a249
e2023249
Memorial Sloan Kettering Skin Cancer Center, New York, USA
2160-9381
en
e2023249
Kurtansky NR, Dusza SW, Halpern AC, Hartman RI, Geller AC, Marghoob AA, Rotemberg VM, Marchetti MA. An Epidemiologic Analysis of Melanoma Overdiagnosis in the United States, 1975-2017. J Invest Dermatol. 2022 Jul;142(7):1804-1811.e6.
Melanoma Overdiagnosis: Historical Perspective and the Path Forward
https://dpcj.org/index.php/dpc/article/download/3750/2332
   Melanoma Over-diagnosis: Historical Perspective
              and the Path Forward
                                                    Ashfaq A. Marghoob1


1 Memorial Sloan Kettering Skin Cancer Center, Hauppauge, New York, USA



Citation: Marghoob AA. Melanoma Overdiagnosis: Historical Perspective and the Path Forward. Dermatol Pract Concept.
2023;13(4):e2023249. DOI: https://doi.org/10.5826/dpc.1304a249
Accepted: August 7, 2023; Published: October 2023
Copyright: ©2023 Marghoob. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Corresponding Author: Ashfaq A. Marghoob, Memorial Sloan Kettering Skin Cancer Center 800 Veterans Memorial Highway, Hauppauge,
NY 11788; Memorial Sloan Kettering Cancer Center 530 East 74th Street, New York, NY 10021 E-mail: marghooa@mskcc.org




Themes emerging from the two opinion pieces regarding               features of early melanoma gave rise to the ABCD mnemonic
melanoma over-diagnosis (MO) include: melanoma in situ              and the concept of the ‘ugly duckling sign” [3,4]. The re-
(MMIS) is the main problem, technology will mitigate the            alization that biology of lesions is a sensitive indicator of
problem, and harms of MO are trivial compared to its re-            melanoma heralded the importance placed on identifying
sulting overtreatment.                                              change [5]. Technological advances including the ability to
   To understand MO requires a historical perspective.              obtain baseline clinical images to assist in more objectively iden-
Armed with evidence-based knowledge acquired in the 1970s           tify change led to use of baseline total body photographs [6].
showing that melanoma prognosis hinged primarily on tu-             Introduction of dermoscopy further enhanced our ability to
mor thickness, combined with the prevailing belief that pri-        identify otherwise difficult to detect melanomas including
mary cutaneous melanoma, if left untreated, would steadily          amelanotic and small diameter melanomas [7]. Today we
grow until it metastasizes and kills the patient, heralded ef-      have ever more sophisticated technology directed towards
forts aimed at early detection [1]. Then in the 1980s Doctor        early melanoma detection including RCM, in vivo gene ex-
Ackerman promoted the concept that the earliest form of             pression profiling, and artificial intelligence. I agree with the
melanoma is when the ‘malignancy’ is confined to the epi-           authors of the opinion pieces that technology, if used appro-
dermis [2]. In his editorial, ‘No one should die of malignant       priately, will reduce unnecessary biopsies of nevi. However,
melanoma’, he implored all physicians to learn the morpho-          any technology designed to detect melanoma cannot possi-
logic features of flat (in situ) melanomas [2]. The intersection    bly reduce MO, as suggested by the authors.
of evidence-based data, belief systems and influential phy-             The aforementioned efforts have delivered on the request
sicians created the prevailing acceptance among clinicians,         of finding early melanoma, including MMIS. The presence
researchers, and epidemiologists that surveillance ought            of countless studies published over the past five decades now
to save lives. And thus, the journey to detect melanoma as          permits us to apply our ‘retrospect-oscope’ and realize that
early as possible began. Investigations into the morphologic        major flaws existed in our belief system. We are now aware




Commentary | Dermatol Pract Concept. 2023;13(4):e2023249                                                                             1
that some melanomas can grow very slowly, that factors other       References
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