Melanoma, the deadliest skin cancer, is being diagnosed at more than double the rate it was in 1986, making it the fastest growing cancer. The reason melanoma is increasing, however, is an arguable subject.
Some dermatologists contend melanoma is becoming more common, recommending regular skin cancer screenings in order to catch it at its earliest stages. Other specialists claim the number of melanoma diagnoses is reflecting increased skin cancer screenings and not a skin cancer epidemic.
In a study published in the current issue of The British Medical Journal, melanoma’s changing incidence and death rate over time was studied, finding skin biopsies have risen at nearly the same rate as the incidence of early stage melanoma. Dr. H. Gilbert Welch of the Department of Veterans Affairs in White River Junction, Vt., and Dartmouth Medical School and his colleagues used Medicare data to track the quickly rising number of melanoma cases since 1986 and data compiled by the National Cancer Institute to track the death rate and the number of people with early and late-stage melanoma.
Since 1986, the researchers found skin biopsies have risen by 250 percent, which is nearly the same as the rise in the incidence of early stage melanoma, while the melanoma death rate has remained steady. The researchers found the incidence of advanced melanoma also remained stable.
The study’s authors argue if a melanoma epidemic was really present scientists would see increases in cancers at all stages. The real question, according to Dr. Welch, is what the real benefit of screening for melanoma is if the death toll from the cancer and number of patients with advanced disease has not been lowered. Though the researchers did not discourage people who notice suspicious moles or spots to see a doctor, they did question skin cancer screenings directed at healthy people that have no reason to believe anything is wrong.
Both the American Cancer Society and American Academy of Dermatology recommends regular skin screenings, and some doctors questioned the study’s conclusion that biopsies were leading to excessive melanoma diagnoses. An oncologist, Dr. Len Lichtenfeld, said his American Cancer Society group reviewed the same data as Dr. Welch, arriving at a different conclusion.
According to Dr. Lichtenfeld, what his group took from the data was a trend indicating that the death rate from the disease rose slightly year by year until about a decade ago, which is consistent with an increase in serious cases of melanoma. Data suggesting the death rates in the Medicare age group are declining is an expected effect if screening is working, but Dr. Welch disagrees. He believes the cancer society was focusing too heavily on the “tiny, tiny differences” in death rates from year to year, saying the death rate has been basically flat since 1986 though it shifts slightly between years because of statistical fluctuations.
Dr. Welch points out the two groups do not disagree with the data, just the interpretation. Regardless of the interpretation of the data, doctors agree there are important arguments made for both sides that raise important questions about the national melanoma epidemic, increased surveillance and saving lives.
Efforts to increase melanoma awareness campaigns have been successful in getting more patients to screenings and monitoring changes in moles, etc., but now doctors are questioning its impact on mortality on late-stage disease. Should the screening programs have no consequence, doctors are saying there are billions of dollars being wasted on merely hype.
The federal Preventative Services Task Force, which makes screening recommendations, said there is still insufficient evidence to warrant changes in skin screening recommendations as of yet.