No one disputes the fact that the number of melanomas being diagnosed is on the rise. Yet whether this in fact represents an epidemic or something far less worrisome is a matter of opinion.
Although a now-infamous study headed by Dartmouth Medical School investigator H. Gilbert Welch, M.D., did indeed determine a nearly 2.5-fold rise based on Medicare and National Cancer Institute data between 1986 and 2001, the epidemic naysayers look instead at another finding from that study: Despite the increase in diagnoses, both the death rate and incidence of advanced stage disease were virtually unchanged.
This trend of increasing melanoma diagnoses continues at a 4% to 6% per year, as does the relatively flat death rate. Is this in fact an epidemic? Weighing in on the debate are four prominent dermatologists, two of whom point directly to the definition of an epidemic to support their opposite viewpoints.
James Spencer, M.D., is Professor of Clinical Dermatology at Mount Sinai School of Medicine and maintains a private practice in St. Petersburg, FL.
He has been vocal about the need for sun-protection measures to head off what he calls a preventable cancer and is a member of the American Academy of Dermatology’s environment committee.
“I wouldn’t call it an epidemic, but the rate is rising, which is surprising because we know what causes it.”
He frames the big question behind the data showing dramatically increased diagnosis rates, with only a slightly higher mortality rate. “Is this real?” he questions.
“I see two possibilities. We’re just simply doing a better job at finding and curing early melanomas, which is why the death rate hasn’t increased. The other possibility is that the disease is being over-diagnosed, that the medical-legal climate pushes pathologists to call lesions likely to be benign melanoma more often.”
That being said, his own belief is that there is a real increase beyond the early diagnoses, which make them curable. “This is good. We’re finding more thin melanomas, more early melanomas and therefore saving lives.”
“Remember, the mortality rate for invasive melanoma is relatively high —close to 20 percent. That number should be zero because melanoma begins on the surface of the skin, where we can see it, and when it’s superficial and early it’s 100 percent curable.”
Raymond Cornelison Jr., M.D., is Professor and Chairman, Department of Dermatology, University of Oklahoma College of Medicine.
Just as his colleagues are, he is concerned about the reported melanoma rate increases, but says the increase is beginning to slow thanks to public education efforts to encourage sun safety and early screening. Furthermore, he isn’t convinced the numbers reflect the true picture, saying,“ There are no solid data one way or the other.”
He believes these higher numbers can be at least partially explained by medical-legal considerations and broader pathological criteria for melanoma determination, which he says results in over-diagnosis.
“For example, 20 years ago, much of what is now called dysplastic nevi would have been called compound nevi, but now you very seldom get a report identifying a “compound nevus,” maintains Dr. Cornelison.
“While you always want to err on the side of caution, this is a problem from a science standpoint because it’s difficult to get solid figures,” he adds.
His own efforts to catch the disease at its earliest include asking patients who present for other conditions to allow him to examine them for lesions — at the very minimum on their backs, which they cannot see themselves.
“My belief is that we’re having an impact on melanomas. Through the Academy’s skin cancer screening clinics and patients self-reporting, we’re picking melanomas up earlier when they are thinner, which is leading to a drop in mortality rates.”
Darrell Rigel, M.D., Clinical Professor of Dermatology at New York University School of Medicine in New York city, makes no secret of his alarm about rising melanoma rates, which he believes are truly increasing apart from stepped-up screening, more liberal histological criteria, and improved counting methods.
“If you look at the definition of an epidemic, which is a disease increasing significantly in rate over time, the answer is “yes”, it meets the definition. But whether you call it an epidemic or not isn’t the issue. Rates have been rising from anywhere from 4% to 6% per year every year in the United States since 1950,” he asserts.
Dr. Rigel sees the increased survival rate combined with increased incidence rate as evidence that the incidence is rising at an even faster rate than the survival rate. What’s more, Dr. Rigel believes these numbers are in fact under-reported, that they would be still higher if melanomas were tracked in hospital tumor registries, like most other major cancers.
“With every other major cancer, at some point, the patient or a specimen hits a hospital tumor registry, which is the primary source of data collection by the government,” he maintains.
“The point is that we are detecting them earlier, but people are still dying of melanomas. Melanoma is the most clear-cut case of a cancer where early detection and treatment are key. If you detect it earlier, the reality is that it can be caught and treated, while once it spreads, there’s nothing you can do.”
And for those who think it’s not important to diagnose in situ melanomas, I’d ask them this: “If it were on you, would you remove it?,” he asks.
A. Bernard Ackerman, M.D., Emeritus Director of the Ackerman Academy of Dermatopathology in New York, calls talk of a causal relationship between sun exposure and melanoma “malarkey.”
In fact, he himself often sports a deep tan obtained the natural way.
“I do not think the sun is responsible for melanoma; I think genes are responsible for melanoma,” he says pointing out that Asians and Africans develop melanoma only on palms, soles, nail units and mucus membranes. In addition, he notes that the most common melanoma sites in Caucasians — women’s legs and men’s torsos — typically receive far less exposure to the sun than the face and arms.
Yet this, among many unpopular positions, notwithstanding, he is world-renowned as a teacher, speaker, and writer in the subspecialty of dermatopathology, and in 2004, he was recognized as by his colleagues through the American Academy of Dermatology’s Master Dermatologist Award.
His newly published book (with Renata Joffe, M.D.), The Sun and the “Epidemic” of Melanoma: Myth on Myth! presents the pros and cons of issues related to the sun and melanoma.
Included in the book are the authors’ “Conclusions Based on the Evidence,” which, collectively, dismiss the purported melanoma epidemic simply as “myth.”
No one disputes the fact that the number of melanomas being diagnosed is on the rise. Yet whether this in fact represents an epidemic or something far less worrisome is a matter of opinion.
Although a now-infamous study headed by Dartmouth Medical School investigator H. Gilbert Welch, M.D., did indeed determine a nearly 2.5-fold rise based on Medicare and National Cancer Institute data between 1986 and 2001, the epidemic naysayers look instead at another finding from that study: Despite the increase in diagnoses, both the death rate and incidence of advanced stage disease were virtually unchanged.
This trend of increasing melanoma diagnoses continues at a 4% to 6% per year, as does the relatively flat death rate. Is this in fact an epidemic? Weighing in on the debate are four prominent dermatologists, two of whom point directly to the definition of an epidemic to support their opposite viewpoints.
James Spencer, M.D., is Professor of Clinical Dermatology at Mount Sinai School of Medicine and maintains a private practice in St. Petersburg, FL.
He has been vocal about the need for sun-protection measures to head off what he calls a preventable cancer and is a member of the American Academy of Dermatology’s environment committee.
“I wouldn’t call it an epidemic, but the rate is rising, which is surprising because we know what causes it.”
He frames the big question behind the data showing dramatically increased diagnosis rates, with only a slightly higher mortality rate. “Is this real?” he questions.
“I see two possibilities. We’re just simply doing a better job at finding and curing early melanomas, which is why the death rate hasn’t increased. The other possibility is that the disease is being over-diagnosed, that the medical-legal climate pushes pathologists to call lesions likely to be benign melanoma more often.”
That being said, his own belief is that there is a real increase beyond the early diagnoses, which make them curable. “This is good. We’re finding more thin melanomas, more early melanomas and therefore saving lives.”
“Remember, the mortality rate for invasive melanoma is relatively high —close to 20 percent. That number should be zero because melanoma begins on the surface of the skin, where we can see it, and when it’s superficial and early it’s 100 percent curable.”
Raymond Cornelison Jr., M.D., is Professor and Chairman, Department of Dermatology, University of Oklahoma College of Medicine.
Just as his colleagues are, he is concerned about the reported melanoma rate increases, but says the increase is beginning to slow thanks to public education efforts to encourage sun safety and early screening. Furthermore, he isn’t convinced the numbers reflect the true picture, saying,“ There are no solid data one way or the other.”
He believes these higher numbers can be at least partially explained by medical-legal considerations and broader pathological criteria for melanoma determination, which he says results in over-diagnosis.
“For example, 20 years ago, much of what is now called dysplastic nevi would have been called compound nevi, but now you very seldom get a report identifying a “compound nevus,” maintains Dr. Cornelison.
“While you always want to err on the side of caution, this is a problem from a science standpoint because it’s difficult to get solid figures,” he adds.
His own efforts to catch the disease at its earliest include asking patients who present for other conditions to allow him to examine them for lesions — at the very minimum on their backs, which they cannot see themselves.
“My belief is that we’re having an impact on melanomas. Through the Academy’s skin cancer screening clinics and patients self-reporting, we’re picking melanomas up earlier when they are thinner, which is leading to a drop in mortality rates.”
Darrell Rigel, M.D., Clinical Professor of Dermatology at New York University School of Medicine in New York city, makes no secret of his alarm about rising melanoma rates, which he believes are truly increasing apart from stepped-up screening, more liberal histological criteria, and improved counting methods.
“If you look at the definition of an epidemic, which is a disease increasing significantly in rate over time, the answer is “yes”, it meets the definition. But whether you call it an epidemic or not isn’t the issue. Rates have been rising from anywhere from 4% to 6% per year every year in the United States since 1950,” he asserts.
Dr. Rigel sees the increased survival rate combined with increased incidence rate as evidence that the incidence is rising at an even faster rate than the survival rate. What’s more, Dr. Rigel believes these numbers are in fact under-reported, that they would be still higher if melanomas were tracked in hospital tumor registries, like most other major cancers.
“With every other major cancer, at some point, the patient or a specimen hits a hospital tumor registry, which is the primary source of data collection by the government,” he maintains.
“The point is that we are detecting them earlier, but people are still dying of melanomas. Melanoma is the most clear-cut case of a cancer where early detection and treatment are key. If you detect it earlier, the reality is that it can be caught and treated, while once it spreads, there’s nothing you can do.”
And for those who think it’s not important to diagnose in situ melanomas, I’d ask them this: “If it were on you, would you remove it?,” he asks.
A. Bernard Ackerman, M.D., Emeritus Director of the Ackerman Academy of Dermatopathology in New York, calls talk of a causal relationship between sun exposure and melanoma “malarkey.”
In fact, he himself often sports a deep tan obtained the natural way.
“I do not think the sun is responsible for melanoma; I think genes are responsible for melanoma,” he says pointing out that Asians and Africans develop melanoma only on palms, soles, nail units and mucus membranes. In addition, he notes that the most common melanoma sites in Caucasians — women’s legs and men’s torsos — typically receive far less exposure to the sun than the face and arms.
Yet this, among many unpopular positions, notwithstanding, he is world-renowned as a teacher, speaker, and writer in the subspecialty of dermatopathology, and in 2004, he was recognized as by his colleagues through the American Academy of Dermatology’s Master Dermatologist Award.
His newly published book (with Renata Joffe, M.D.), The Sun and the “Epidemic” of Melanoma: Myth on Myth! presents the pros and cons of issues related to the sun and melanoma.
Included in the book are the authors’ “Conclusions Based on the Evidence,” which, collectively, dismiss the purported melanoma epidemic simply as “myth.”
No one disputes the fact that the number of melanomas being diagnosed is on the rise. Yet whether this in fact represents an epidemic or something far less worrisome is a matter of opinion.
Although a now-infamous study headed by Dartmouth Medical School investigator H. Gilbert Welch, M.D., did indeed determine a nearly 2.5-fold rise based on Medicare and National Cancer Institute data between 1986 and 2001, the epidemic naysayers look instead at another finding from that study: Despite the increase in diagnoses, both the death rate and incidence of advanced stage disease were virtually unchanged.
This trend of increasing melanoma diagnoses continues at a 4% to 6% per year, as does the relatively flat death rate. Is this in fact an epidemic? Weighing in on the debate are four prominent dermatologists, two of whom point directly to the definition of an epidemic to support their opposite viewpoints.
James Spencer, M.D., is Professor of Clinical Dermatology at Mount Sinai School of Medicine and maintains a private practice in St. Petersburg, FL.
He has been vocal about the need for sun-protection measures to head off what he calls a preventable cancer and is a member of the American Academy of Dermatology’s environment committee.
“I wouldn’t call it an epidemic, but the rate is rising, which is surprising because we know what causes it.”
He frames the big question behind the data showing dramatically increased diagnosis rates, with only a slightly higher mortality rate. “Is this real?” he questions.
“I see two possibilities. We’re just simply doing a better job at finding and curing early melanomas, which is why the death rate hasn’t increased. The other possibility is that the disease is being over-diagnosed, that the medical-legal climate pushes pathologists to call lesions likely to be benign melanoma more often.”
That being said, his own belief is that there is a real increase beyond the early diagnoses, which make them curable. “This is good. We’re finding more thin melanomas, more early melanomas and therefore saving lives.”
“Remember, the mortality rate for invasive melanoma is relatively high —close to 20 percent. That number should be zero because melanoma begins on the surface of the skin, where we can see it, and when it’s superficial and early it’s 100 percent curable.”
Raymond Cornelison Jr., M.D., is Professor and Chairman, Department of Dermatology, University of Oklahoma College of Medicine.
Just as his colleagues are, he is concerned about the reported melanoma rate increases, but says the increase is beginning to slow thanks to public education efforts to encourage sun safety and early screening. Furthermore, he isn’t convinced the numbers reflect the true picture, saying,“ There are no solid data one way or the other.”
He believes these higher numbers can be at least partially explained by medical-legal considerations and broader pathological criteria for melanoma determination, which he says results in over-diagnosis.
“For example, 20 years ago, much of what is now called dysplastic nevi would have been called compound nevi, but now you very seldom get a report identifying a “compound nevus,” maintains Dr. Cornelison.
“While you always want to err on the side of caution, this is a problem from a science standpoint because it’s difficult to get solid figures,” he adds.
His own efforts to catch the disease at its earliest include asking patients who present for other conditions to allow him to examine them for lesions — at the very minimum on their backs, which they cannot see themselves.
“My belief is that we’re having an impact on melanomas. Through the Academy’s skin cancer screening clinics and patients self-reporting, we’re picking melanomas up earlier when they are thinner, which is leading to a drop in mortality rates.”
Darrell Rigel, M.D., Clinical Professor of Dermatology at New York University School of Medicine in New York city, makes no secret of his alarm about rising melanoma rates, which he believes are truly increasing apart from stepped-up screening, more liberal histological criteria, and improved counting methods.
“If you look at the definition of an epidemic, which is a disease increasing significantly in rate over time, the answer is “yes”, it meets the definition. But whether you call it an epidemic or not isn’t the issue. Rates have been rising from anywhere from 4% to 6% per year every year in the United States since 1950,” he asserts.
Dr. Rigel sees the increased survival rate combined with increased incidence rate as evidence that the incidence is rising at an even faster rate than the survival rate. What’s more, Dr. Rigel believes these numbers are in fact under-reported, that they would be still higher if melanomas were tracked in hospital tumor registries, like most other major cancers.
“With every other major cancer, at some point, the patient or a specimen hits a hospital tumor registry, which is the primary source of data collection by the government,” he maintains.
“The point is that we are detecting them earlier, but people are still dying of melanomas. Melanoma is the most clear-cut case of a cancer where early detection and treatment are key. If you detect it earlier, the reality is that it can be caught and treated, while once it spreads, there’s nothing you can do.”
And for those who think it’s not important to diagnose in situ melanomas, I’d ask them this: “If it were on you, would you remove it?,” he asks.
A. Bernard Ackerman, M.D., Emeritus Director of the Ackerman Academy of Dermatopathology in New York, calls talk of a causal relationship between sun exposure and melanoma “malarkey.”
In fact, he himself often sports a deep tan obtained the natural way.
“I do not think the sun is responsible for melanoma; I think genes are responsible for melanoma,” he says pointing out that Asians and Africans develop melanoma only on palms, soles, nail units and mucus membranes. In addition, he notes that the most common melanoma sites in Caucasians — women’s legs and men’s torsos — typically receive far less exposure to the sun than the face and arms.
Yet this, among many unpopular positions, notwithstanding, he is world-renowned as a teacher, speaker, and writer in the subspecialty of dermatopathology, and in 2004, he was recognized as by his colleagues through the American Academy of Dermatology’s Master Dermatologist Award.
His newly published book (with Renata Joffe, M.D.), The Sun and the “Epidemic” of Melanoma: Myth on Myth! presents the pros and cons of issues related to the sun and melanoma.
Included in the book are the authors’ “Conclusions Based on the Evidence,” which, collectively, dismiss the purported melanoma epidemic simply as “myth.”
