By: Maayan S. Heller for Body1To be over-cautious or not to be? That is the question – or at least it seems to be the question on the minds of many American dermatologists and oncologists since recently-published research suggests that melanoma – skin cancer – is being over-diagnosed in the United States.
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Be vigilant and informed about your skin:
Monitor any moles or marks on your skin regularly – if the shape, color or size change, contact your doctor.
Know your family history – genetics can play a role in melanoma, as in many medical issues. Make sure your doctor knows your family history.
The procedure to remove a concerning lesion or mark on your skin is a very simple one.
Surgically removing a mole will leave a small scar (size will vary with the size of the mole), so many doctors recommend discussing the timeliness of removal with patients and watching a mole for a while before simply removing it – not all moles are cancerous melanomas.
The procedure to remove the mole is considered minimally invasive, is very straightforward in most cases and is done with a local anesthesia on an out-patient basis (no overnights at the hospital).
While you may be nervous about scarring on your face, you should be aware that the face is more forgiving and doesn’t car as drastically as the chest or arm. Legs are notorious for scarring
The only long-term issue with removing a mole is cosmetic, so if you’re concerned at all about the potential dangers of a mole go to the doctor right away.
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In an article published online by the British Medical Journal (BMJ) on August 4, 2005, said researchers examined skin biopsy rates between 1986 and 2001 and concluded that the incidence of skin melanoma is rising faster than any other major cancer in the U.S. They also found that the average incidence of melanoma increased 2.4-fold, from 45 to 108 per 100,000 people.But Hensin Tsao, MD, PhD, Director of the Pigmented Lesion Center at Massachusetts General Hospital in Boston, is cautious about accepting the research as conclusive.
“I’m not saying the study is wrong,” said Dr. Tsao. “But we need to look at all the things that are unknown here. There are so many variables that are unknown.”
He pointed out that in the time period examined, the overall number of biopsies was rising, which led to an increase in detected melanomas. The actual numbers of melanomas may not have actually changed; just the number of those caught may be what has risen over time.
“This is a current suspicion without much direct supportive evidence,” added Arthur Sober, MD, also from the Department of Dermatology at Mass General.
The doctors’ criticism of the research mainly addresses the likely restrictions of the study, which include age variables and limited resources.
The study utilized two main sources: The National Cancer Institute’s SEER (Surveillance Epidemiology and End Results) Registry and Medicare data. The research only looked at patients within those sources who were 65 or older and within nine geographical regions in the U.S.
According to its Web site “the SEER Program currently collects and publishes cancer incidence and survival data from 14 population-based cancer registries and three supplemental registries covering approximately 26 percent of the U.S. population.” This already limits the breadth of accuracy possible in projecting the data to the larger population.
“No one is looking at all the melanoma cases,” said Dr. Tsao. “No one has that data.”
Dr. Tsao said he believes the limitations of the study reach beyond the age boundaries of the patients researched. The more significant flaw seems to lie in the fact that it focused only on one variable: Increased biopsies. He added that there is too much unknown data to be able to draw an accurate conclusion at this time.
One important variable might be that patients have become much more vigilant when it comes to their skin. An increase of information availability, especially with the rise of the internet, has led to an enhanced public awareness of dangers and warning signs. People are just more careful.
“Dermatological visits have doubled since 1974,” Dr. Tsao noted.
Dr. Tsao said he thinks there are a variety of elements “conspiring to show increasing melanoma rates nationally.”
“Could we be over detecting? Maybe,” he said. “But 20 years ago [melanoma] was probably under detected.”
So is an over-cautious dermatologist a bad thing? It seems we’re catching more melanomas than before, and most would agree that’s a good thing.
Ultimately, said Dr. Tsao, “we can’t relax the vigilance, because you just can’t ever tell for sure. You can’t say by looking at a small brown spot what the behavior of that spot will be over the next weeks, months, years.”
So it seems that many dermatologists are probably removing some lesions on the skin that are not – and would not become – cancerous, but they’re also removing more that are.
