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A look at the “melanoma epidemic”

Posted on: October 5, 2011   by  John Cannell, MD

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We have all read about the “melanoma epidemic” and how sun exposure and sunbeds are causing it. However, little did I know that the “epidemic” is actually an artifact caused by “diagnostic drift.” Sometimes papers are so well written, so readable, so revolutionary, and so important, I will write about them even though they are a few years old, especially with a title like this one.

Levell NJ, Beattie CC, Shuster S, Greenberg DC. Melanoma epidemic: a midsummer night’s dream? Br J Dermatol. 2009 Sep;161(3):630-4.

“There is widespread belief that excessive ultraviolet exposure has led to an increased incidence of melanoma and this has been passed on to the public in an alarmist way…If the increased incidence was real, there would be an increase in all the usual presentational forms of the lesions, from minimal to advanced, as well as the mortality from them; but if the explanation is diagnostic drift, the increased incidence would be entirely due to minimal lesions, and there would be little or no change in mortality or incidence of more advanced disease.”Four British dermatologists looked at 3,971 melanoma cases in East Anglia from 1991 to 2004. They started by saying,

From 1991 to 2004, they found exactly that with only a tiny increase in mortality but no increase in stage two, three, or four melanoma, only a dramatic increase in stage one disease.

“The level of coincidence necessary to make the reported melanoma mountain credible is too extraordinary to countenance . . . Dermatologists, pathologist and other medical practitioners have become more cautious in the last two decades, as the consequences of a wrong diagnosis have become more pervasive. One mistake can be ruinous; fear of humiliation and disgrace has increased, and compensation has outbid apology.”

They suggest a blind pathological comparison of modern lesions with lesions from 40 years ago to clarify the point. Furthermore, they found the increased incidence was mostly on the back, trunk and limbs, and not on the face and neck, which are the main sites of UV induced cancers.

“Until the necessary research is done, and the true story is established, including proof or refutation of our evidence that the reported increase in ‘melanoma’ is due to reclassification of benign lesions, encouragement of public anxiety about a melanoma epidemic and excessive avoidance of solar exposure for its prevention is unjustifiable.”

They conclude,

“These finding inevitably challenge the validity of epidemiological studies linking increased melanoma incidence with UV radiation and suggest the need for a search for other ways in which the disease may be caused.”

Imagine a “pneumonia epidemic” that had no increase in fever, cough, chills, hospitalizations, doctor’s visits, or clinical signs of pneumonia, only a dramatic increase in radiologists reading CXRs as pneumonia. Something would not compute. That is exactly what is happening with the “melanoma epidemic.” It seems dermatologists and pathologists are causing the “melanoma epidemic,” not UV radiation.

2 Responses to A look at the “melanoma epidemic”

  1. anniecmars@yahoo.com.au

    Our new and wonderful world of early diagnosis is great for some things, but as in this case, it is also picking up lots of “diseases” that may go undiagnosed without the new tests; they are often asymptomatic and require no treatment. For example many people live with gallstones without knowing it, they have no symptoms and their gallstones are diagnosed when they are being tested for something else – same for such things as benign uterine fibroids, benign thyroid nodules, and a host of other benign lumps and bumps that only picked up as part of tests being carried out for other things. With consumer knowledge and encouragement to seek tests for anything going as well as the multitude of test types available and effective, we are getting much higher numbers of diagnoses of a multitude of otherwise unrecognised “abnormalities”

  2. Nandyal

    The lack of correlation of melanoma with UV exposed areas seems to let UV off the hook.
    Would the study results be different in more southerly latitudes.? East Anglia is pretty far north! I’m no dermatologist, just playing the devils advocate.

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