The melanoma epidemic: reality and artefact

Warrants a reappraisal of the relation between histology and clinical behaviour

Skin watchers have their own equivalent of the Heisenberg uncertainty principle. Just as you can't know exactly both the momentum and the position of a single electron, once you excise a pigmented lesion and know its histology you forfeit the chance of knowing what would have happened if you had left it in situ; progression, metastasis, or even involution are all possible. Removal of pigmented lesions is now one of the commonest surgical procedures and has radically changed the pattern of referrals to dermatologists. Epidemiological studies show a dramatic increase in histologically confirmed melanomas1 and raise the important questions of whether the increase is real or a diagnostic artefact and whether we should reconsider the relation between sun exposure and melanoma.

The incidence of melanoma has increased by 3-7% per year from the mid-1950s to the early 1980s.1 2 3 These changes have been seen in both sexes and in a large number of different caucasian communities in both the …