Melanoma screening remains extremely popular. Over the last 40 years the incidence of melanoma has increased 6 fold. Melanoma screening is offered to the public as a preventive against the consequences of the disease, metastasis and death. But whether melanoma screening delivers on its promise or instead dramatically boosts the likelihood of overdiagnosis of lesions unlikely to cause harm remains an issue.

Due to melanoma screening, melanoma of the skin now ranks as the 3rd most prevalent cancer just behind breast and lung cancer. More than 200,000 cases will be diagnosed this year with the number of invasive lesions equal to the number of very superficial, non-invasive malignant melanoma in situ. During this same time period the incidence of thyroid cancer increased only 3 fold while breast cancer rose by only 50%.

An article in the January 7, 2021 edition of The New England Journal of Medicine written by eminent physician researchers specializing in public health, pathology and dermatology investigated this situation. They find that in spite of the incidence rising 600% the death rate remained unchanged over the 40 year time frame.

The threshold for diagnosing melanoma on clinical grounds and by microscopic analysis appears considerably less stringent that in the past. Pathologists asked to reevaluate biopsy specimens from 20 years ago changed the diagnosis from a benign lesion to melanoma in a considerable number of cases.

Additionally media focus on melanoma screening has sensitized people to the potential hazards of the disease. But the American Academy of Dermatology discontinued their “Spot Me” campaign when dermatologists suggested further evaluation for possible melanoma in an exorbitant number of those attending melanoma screening.

Financial incentives and utilization of magnifying dermoscopy and now artificial intelligence further worsen the situation.