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Skin Cancer Overdiagnosis?

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“The discrepancies in incidence and mortality trends found in this cohort study suggest considerable overdiagnosis of melanoma occurring among White patients in the US.”

Though the studies linked and excerpted below do make a good case for the over-diagnosis of melanoma, my experience as a long-term cancer survivor (blood cancer) who has been diagnosed with Basal Cell Carcinoma (BCC) tells me that the diagnosis of skin cancer has dramatically increased over the past couple of generations.

Let me be clear. Skin cancer as well as many other cancers are over-diagnosed. DCIS and early stage PCa over diagnoses are well documented. But this doesn’t mean that you should ignore it if you have been diagnosed with skin cancer.

I’ve had 5 suspicions looking moles removed and biopsied and another 3-4 patches frozen aka cryotherapied; I watch my skin like a hawk.

If you have been told that you have skin cancer your challenge is that your risk of melanoma and/or disfigurement is real. While the risk of non-melanoma skin cancers such as Basal Cell or Squamous Cell Carcinoma becoming full blown melanoma is small, it is in your interests to takes steps to reduce your risk of progression. More importantly, you can take steps to pursue evidence-based, non-conventional therapies , that will reduce your risk of melanoma and make your skin look better.

Non-Melanoma Skin Cancer at a Glance-

  • Risks– UV Exposure, HPV, Genetics, Skin Pigment, Immunosuppression, Radiation Therapy, Age, Previous Skin Cancer,
  • Symptoms– Itching, Bleeding, Shape (A,B,C,D,E).
  • Diagnosis– Visual inspection (A,B,C,D,E), Skin Biopsy (Shave, Punch, Incisional/Excisional)
  • Prognosis- Staging-
  • Therapy– Conventional, Non-Conventional, Integrative, Alternative

A host of evidence-based but non-toxic therapies have been shown to reduce the risk of a skin cancer diagnosis.

Evidence-based but non-toxic, non-conventional therapies such:
  • Curcumin
  • Green Tea Extract
  • Vitamin D3
  • Resveratrol
  • Milk Thistle
  • Omega-3
  • Anti-angiogenic nutrition
  • Exercise

I do/take all the therapies above to reduce my risk of a skin cancer diagnosis. Further, I am not afraid to see a dermatologist and have him/her remove and biopsy suspicious looking anything.

If you have any question about managing your own skin cancer/melanoma, scroll down the page, post a question and I will reply to you ASAP.

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Study Suggests Awareness Alone Will Not Solve Skin Cancer Overdiagnosis Issue

More experienced dermatopathologists were less likely to see overdiagnosis as a significant public health problem, a new survey showed.

Many dermatopathologists understand that overdiagnosis of skin cancer is a significant problem, according to a new study, but that does not translate into significant alterations in how they diagnose potential cases.

Although melanoma is becoming more prevalent, mortality from the cancer is not. The study investigators wrote in JAMA Dermatology that this imbalance suggests melanoma is often being diagnosed unnecessarily.

“Previous research has shown that different pathologists who examine the same skin biopsy will sometimes give different diagnoses—to a very surprising degree,” said Kathleen Kerr, PhD, MS, MA, professor of biostatistics, University of Washington, and lead author, in a statement announcing the findings.“The same pathologist examining the same case on 2 different occasions might even give 2 substantially different diagnoses.”

Yet, while the issue of overdiagnosis itself has been studied at an epidemiological level, the perceptions and practices of clinicians have not been the subject of significant study. The authors turned to 115 board-certified or fellowship-trained dermatopathologists and asked them to give their perceptions of overdiagnosis. They also asked them to give diagnostic interpretations of 18 skin biopsy cases, made up of 5 slide sets with 90 melanocytic skin lesions.

The authors found awareness of overdiagnosis, but to differing degrees. Sixty-eight percentg of the dermatopathologists agreed that overdiagnosis is a public health issue for atypical nevi, 47% said the same thing about melanoma in situ, and 35% identified overdiagnosis of invasive melanoma as a public health issue…

The investigators highlighted that the overdiagnosis problem is multifaceted. On the one hand, patients tend to assume that any skin abnormality should be biopsied and that the results of biopsies are definitive. Moreover, both doctors and physicians are wary of missing cancer, perhaps creating a bias toward positive diagnosis…”

Estimating Overdiagnosis of Melanoma Using Trends Among Black and White Patients in the US

Importance  The incidence of cutaneous melanoma has been rising rapidly among White patients in the US; however, a commensurate increase in mortality due to melanoma has not been observed. These trends suggest overdiagnosis is occurring.

Objective  To quantify melanoma overdiagnosis among White patients compared with Black patients in the US…

Main Outcomes and Measures  Proportion of melanoma cases overdiagnosed among White patients in 2014.

Results  From 1975 to 2014, melanoma incidence increased approximately 4-fold in White women (incidence rate ratio [IRR], 4.01 [95% CI, 3.65-4.41]) and 6-fold in White men (IRR, 5.97 [95% CI, 5.47-6.52]), whereas it increased less than 25% in Black women (IRR, 1.21 [95% CI, 0.97-1.49]) and men (IRR, 1.17; [95% CI, 0.77-1.78]).

Mortality due to melanoma decreased approximately 25% in Black women (morality rate ratio [MRR], 0.76 [95% CI, 0.63-0.90]) and men (MRR, 0.72 [95% CI, 0.62-0.84]), was stable in White women (MRR, 1.02 [95% CI, 0.96-1.09]), and increased almost 50% in White men (MRR, 1.49 [95% CI, 1.25-1.77]).

Had medical care not improved, estimated mortality would have increased 60% in White women and more than doubled in White men. Based on these trends, an estimated 59% (95% CI, 45%-70%) of White women and 60% (95% CI, 32%-75%) of White men with melanoma were overdiagnosed in 2014.

Conclusions and Relevance  The discrepancies in incidence and mortality trends found in this cohort study suggest considerable overdiagnosis of melanoma occurring among White patients in the US.

Melanoma epidemic: a midsummer night’s dream?

“The reported incidence of melanoma has greatly increased and this has been attributed to ultraviolet exposure…

We considered the possibility that the increase was an artefact caused by diagnostic drift…We tested this by analysing the histological diagnosis, mortality and incidence of all lesions reported as melanomas in East Anglia between 1991 and 2004…

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…

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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Dermoscopy is the Key To Skin Cancer Diagnosis- PeopleBeatingCancer says 7 years ago

[…] good argument can be made for skin cancer over diagnosis. And, according to the studies linked and excerpted below, a good argument can be made for the […]

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