Melanoma is overdiagnosed at ‘alarming’ rates.

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I came across this article on Nat Geo and kind of makes you wonder what the hell is going on in this world. Are doctors over diagnosing these melanomas intentionally to make more money? Do they realize what the diagnosis cancer does to people? It scares the living shit out of them. I hope I a wrong in this assumption. I guess working in the medical professin for over 20 years has made me a little jaded.

A recent study finds that many Americans are being told they have skin cancer unnecessarily. Experts weigh in on why that’s happening—and whether you should get an annual screening.

Melanoma diagnoses increased sharply over the years but overall death rates remained flat, a sign that there really isn’t an epidemic of skin cancer, but rather that patients are being overdiagnosed.

More than 80,000 Americans are told each year they have melanoma skin cancer. If that sounds like a lot, it’s because the numbers are six times higher than they were 40 years ago. But rather than resulting from increased environmental risk factors or more thorough detection, experts increasingly attribute the jump to overdiagnosis. A recent paper published in the journal BMJ Evidence-Based Medicine adds to mounting evidence that the majority of people in the United States are receiving melanoma diagnoses unnecessarily. The research suggests that though cells biopsied from their skin may look abnormal under the microscope, they are unlikely to lead to current or future health problems.

“I don’t think enough people understand the potential scope of how much melanoma is overdiagnosed. It’s quite alarming,” says the study’s lead author Adewole Adamson, a dermatologist at Dell Medical School at the University of Texas at Austin. “You’re catching tumors that never would have caused harm.”

The researchers conclude that 65 percent of white women and 50 percent of white men are overdiagnosed after they compared overall mortality rates with the lifetime risk of receiving a melanoma diagnosis. The study was limited to white people, a group significantly more likely to develop the disease.

The largest category of overdiagnoses, more than 85 percent, happened with the thinnest moles on the outermost layer of the skin, known as stage 0 or in situ cancers, the study found.

Overdiagnosis is one of the most harmful and costly problems in medicine, according to an editorial published several years ago. This is because it leads to unnecessary treatments, with the resulting financial costs and scarring. Patients diagnosed with melanoma may not be able to buy life insurance. And people learning they have cancer often experience an intensive fear that can last a lifetime.

“Patients talk about their fear of dying, fear of the sun, fear of the cancer coming back. Some make drastic decisions about whether they are going to get married or have kids,” Adamson says. “We are harming a significant number of people.”

Cancers that really aren’t

Melanoma is the most dangerous form of skin cancer, because in later stages it can spread throughout the body and in a small percentage of cases leads to death.

When dermatologists notice moles on a patient they are uncertain about, they take a biopsy and send it to a pathologist who reviews the cells under a high-powered microscope. If the diagnosis comes back as cancer, the patient returns to the doctor to remove the entire growth and a small area around it.

“It’s a bigger surgery with a bigger scar” than the biopsy sample, says Nicholas Gulati, director of the Early Detection of Skin Cancer Clinic at the Icahn School of Medicine at Mount Sinai in New York.

In many cases, diagnosing melanoma is a judgment call made by pathologists.

“In every organ system—not just skin—there are things that look like cancer…under the microscope,” but don’t in fact behave like cancer, says Earl Glusac, a dermatopathology researcher at Yale Cancer Center who detailed his concerns about melanoma overdiagnosis more than a decade ago.

A review article concluded that existing standards fail to properly distinguish the skin growths that are actually innocuous. That many are indeed harmless was documented in a study published in June that concludes people with melanoma in situ actually live longer than those without the diagnosis, which indicates “significant detection of low-risk disease among health-seeking individuals.”

Glusac believes a key reason behind the rise in overdiagnoses of early melanomas is that more people are being screened for skin cancer; with more moles examined, more fall into this gray category. Additionally, for reasons that are unclear, dermatology conventions have changed the size of moles that should be biopsied. According to Glusac, dermatologists once limited testing to moles the size of a dime or larger while now they’ll test growths at one-fifth that size.

Glusac also points to the growing problem of pathologists calling early lesions melanomas to avoid potential malpractice judgements, as melanoma is one of the leading categories of pathology lawsuits.

“No dermatologist wants to see someone walk in and then out of their office with something that could be a melanoma they haven’t sampled,” Glusac says. “And pathologists don’t want to miss a melanoma—someone could die as a result of your mistake.”

Most people shouldn’t get annual screens

No clinical trials have been conducted to document the effectiveness of screening everyone to spot these early cancers. A panel of experts at the U.S. Preventive Services Task Force concluded in April against recommending regular skin cancer screens for everyone.

Some groups, such as the nonprofit Skin Cancer Foundation, nonetheless advocate annual skin checks. The American Academy of Dermatology, comprised of medical professionals, does not take that stand, but the group does encourage its members to conduct periodic screenings among the general public in their communities.

Doctors agree that people should regularly examine their own skin and seek out a dermatologist if they see any spots that are new or changing or that itch or bleed. It’s important to have these growths evaluated with a biopsy, because the doctor can’t tell if it is invasive cancer just by looking at it, Gulati says.

Adamson wants dermatologists to be honest with patients about the lack of science behind regular full-body checks. He also wants a large, long-term clinical trial conducted that follows people who get screened with those who do not to determine if there are in fact any health benefits in finding and removing these stage 0 cancers.

“I think we should not be promoting screening for melanoma in people who have no symptoms,” he says. “There’s been this push to find these melanomas early, and this overdiagnosis is an unintended consequence of that.”

Melanoma Skin Cancer, Types, Stages, Signs, Symptoms & Treatment

Melanoma, also known as malignant melanoma and cutaneous melanoma, is a type of skin cancer that develops anywhere on the skin. Melanoma occurs when melanocytes (cells that produce a brown pigment called melanin) responsible for the tan or brown colour of the skin, mutates and start growing uncontrollably.

It may develop anywhere on the skin but generally, it starts affecting the chest and back, in case of men and legs, in case of women. Other common areas include the face and neck. It may also develop in the eyes, mouth, anal area and genitals but chances of melanoma occurring here are much less than on the skin. Likewise, people with a darker skin tone have a lesser chance of developing melanoma.

Although lesser in occurrence compared to other types of skin cancers, it is more hazardous as it easily spreads to other parts of the body if not diagnosed and treated early.

Melanoma Skin Cancer Types

Melanoma can be categorized into 4 types

Superficial Spreading Melanoma

It is the most common type of melanoma that generally appears on the torso or limbs. Here, the cells have a slow growth rate at first which starts escalating rapidly once it spreads across the surface of the skin.

Nodular Melanoma

It is the most aggressive type of melanoma that may be reddish or blue-black in color; it generally grows faster than other melanomas. It is the second most common type of melanoma that may appear on the areas of the torso, head or neck.

Lentigo Maligna Melanoma

It generally occurs on parts of the body that have been exposed to the sun excessively over several years, such as the face. It is found more in older adults and is less common. Its representation may be in the form of a stain on the skin known as Hutchinson’s freckle or lentigo maligna. It is less hazardous than other types and generally grows slowly.

Acral Lentiginous Melanoma

It may develop on the soles of feet, palms of hands or beneath the nails and is the rarest type of melanoma.

Although other types of melanoma do not develop in people with darker skin usually, acral lentiginous melanoma is the most common in people with a darker skin tone.

Stages and Grades of Melanoma

To determine the stage of cancer, doctors may use the system of TNM. In the TNM structure, T stands for the thickness of the original tumor and whether it has ulcerated while N stands for cancer that has spread beyond the original tumor to the nearby lymph nodes and M indicates if cancer has spread to other organs such as lungs or brain or to other distant lymph nodes.

After the TNM system is categorized and identified, the doctors will identify the stage in which cancer lies.

Early-Stage Melanoma

Stage 0- This stage is also known as melanoma in situ as it is present only in the outermost layer of the skin and has not yet advanced deeper.

Stage I- Cancer in this stage has advanced to the next layer of the skin from the outermost layer and is smaller than 1mm in Breslow Depth. Cancer in this stage may or may not have been ulcerated.

Intermediate or High-Risk Melanoma

Stage II- The tumors in this stage advance deeper than 1mm into the layer of the skin but they may or may not be ulcerated. The risk of spreading to other parts is high and so doctors may ask you to have a sentinel lymph node biopsy (SLNB) to examine if melanoma cells have spread to the local lymph nodes.

Advanced Melanoma

Stage III- In this stage, the tumor has spread to the local lymph nodes. Sometimes, the tumor may not have reached the local lymph nodes but may have reached the lymph vessels more than 2 cm away from the primary tumor.

Stage IV– In this stage, cancer has advanced to other parts of the body such as lymph nodes, brain, lungs, liver, bone and the gastrointestinal tract. To determine the extent and degree of the advancement of melanoma, doctors may examine the site of the distant tumors and also the level of elevated serum lactate dehydrogenase (LDH). (LDH is an enzyme that converts sugar into energy but it may be harmful if it is found more in blood or body fluids.)

Signs & Symptoms of Melanoma Skin Cancer

Any new spot on the body or an evolving spot unusual in shape, size, or color may be the most essential warning sign of melanoma. In case, a spot looks completely different from all other spots on your body, known as ugly duckling sign, consult a dermatologist.

You may also follow the ABCDE rule that helps in guiding you about the signs of melanoma. The ABCDE rule is described as follows:

A for Asymmetry: Spots or moles on the body do not match the others.

B for Border: The border or the edge of the spot or mole is uneven, rough, and vague.

C for Color: The color of the spot may have different patches of red, blue, pink, or white and even may have shades of brown or black.

D for Diameter: Spots larger than 6 millimeters across (approximately one-fourth of an inch or the size of the pencil eraser) may also be a sign of developing melanoma.

E for Evolving: Any change in size, shape or color of the spot or mole.

Consult your dermatologist if you are not sure of any mole as the difference between melanoma and an ordinary mole may be hard to distinguish.

Risk Factors of Melanoma Skin Cancer

There are various factors that may play a role in increasing the risk of melanoma skin cancer. Some of them are as follows:

Excessive exposure to the sun which may lead to the development of freckles on the skin.
Persons having a high number of moles or having a high number of unusual moles on their bodies.
Presence of age spots or liver spots also known as actinic lentigines.
Presence of a giant brown birthmark known as congenital melanocytic nevi.
Persons with lighter eyes and light or red hair.
Exposure to excessive and irregular sunlight which may cause sunburns is also another factor.
Organ transplant in the past.
Any record of family or personal history of having melanoma.

Diagnostic Procedures

The tests and procedures that are used to diagnose melanomas at are illustrated as below:

Physical exam– This includes examining your skin to see if there is any sign that may be a symptom of melanoma. Your doctor may inquire about your health history.

Removing a sample of tissue for testing (biopsy) – On suspecting that a skin lesion is a melanoma, your doctor may remove the sample of the skin to send it to a lab for its test and examination.

After you are diagnosed with melanoma, the doctor will examine the extent to which melanoma has spread. This process is known as staging. How much cancer is in the body and how dangerous it can be is determined by the stage of cancer.

Melanoma skin cancer treatment and its types

The size and stage of melanoma skin cancer, your health, and your personal choices will determine which type of treatment will be best for you.

Treatment for Early-Stage Melanoma

Early-stage melanoma is treated by surgery in which the surgeon will eliminate the cancer as well as a part of the normal skin including the layer of tissue under the skin. The surgeon may also remove a very thin melanoma entirely during the biopsy after which you may not require any treatment.

Treatment for Melanoma that has spread beyond the skin

Surgery- Melanoma that has spread to nearby lymph nodes is treated by removing the affected nodes. The surgeon may also recommend additional treatments before or after the surgery if needed.

Immunotherapy- It is a drug treatment that enhances the immune system to fight cancer. It may be injected directly into the melanoma when the cancer cannot be removed completely with surgery. That is why, this therapy is generally recommended after surgery when the melanoma has spread to the lymph nodes or to other parts of the body.

Targeted Therapy- In this treatment, a drug is given to target the specific weaknesses present within the cancer cells and thus destroying them. Tests may be done on the cells from your melanoma to determine whether the targeted therapy is effective against your cancer or not.

Radiation Therapy– In this treatment, high doses of energy beams are targeted at the cancer cells to destroy them. This therapy may be helpful in treating those melanomas that cannot be removed completely with surgery. It also helps in relieving symptoms if the melanoma has spread to other parts of the body.

Chemotherapy-In this treatment, a drug is used to destroy cancer cells. This drug has to travel throughout the body and so it may be given intravenously or in pill form or both. Chemotherapy may be also given in a procedure known as isolated limb perfusion in which the drug may be given in a vein of the arm or leg. During this procedure, the blood in the arm or leg is restricted to travel to other parts of your body for a short period of time such that the chemotherapy drug travels directly to the part having melanoma and not affecting other parts of your body.

Resources

nationalgeographic.com, “Melanoma is overdiagnosed at ‘alarming’ rates. Here’s what to know.” By MERYL DAVIDS LANDAU; https://www.yashodahealthcare.com/, “Melanoma Skin Cancer, Types, Stages, Signs, Symptoms & Treatment.”;

Common Sense and Ramblings In America

Melanoma is overdiagnosed at ‘alarming’ rates.

Cancers that really aren’t

Most people shouldn’t get annual screens

Melanoma Skin Cancer Types

Superficial Spreading Melanoma

Nodular Melanoma

Lentigo Maligna Melanoma

Acral Lentiginous Melanoma

Stages and Grades of Melanoma

Early-Stage Melanoma

Intermediate or High-Risk Melanoma

Advanced Melanoma

Signs & Symptoms of Melanoma Skin Cancer

Risk Factors of Melanoma Skin Cancer

Diagnostic Procedures

Melanoma skin cancer treatment and its types

Treatment for Early-Stage Melanoma

Treatment for Melanoma that has spread beyond the skin

Like this:

Cancers that really aren’t

Most people shouldn’t get annual screens

Melanoma Skin Cancer Types

Superficial Spreading Melanoma

Nodular Melanoma

Lentigo Maligna Melanoma

Acral Lentiginous Melanoma

Stages and Grades of Melanoma

Early-Stage Melanoma

Intermediate or High-Risk Melanoma

Advanced Melanoma

Signs & Symptoms of Melanoma Skin Cancer

Risk Factors of Melanoma Skin Cancer

Diagnostic Procedures

Melanoma skin cancer treatment and its types

Treatment for Early-Stage Melanoma

Treatment for Melanoma that has spread beyond the skin

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