Is 'overdiagnosis' a price worth paying in melanoma?

New evidence shows the regions with the highest rate of melanoma diagnosis — which likely have the highest rate of ‘overdiagnosis’ — also have the highest survival

A 45-year-old woman presents for a skin examination. The patient is routinely asked if there are any new or changing lesions of concern.

She mentions that a minute lesion on her left leg has appeared since her last visit (figure A).

Dermoscopy reveals a pigmented lesion that is 1.5mm in diameter. It has no chaos or compelling clues to malignancy and is not at the examiner’s threshold for excision biopsy (figure B).

The lesion is photo-documented and the patient asked to return for review in six months.

At the follow-up review, reimaging reveals significant dermatoscopic changes, including a doubling in size, marked asymmetry and the clue to malignancy of white lines (figure C).

Excision biopsy reveals a thin invasive melanoma, 3mm in diameter, with a Breslow thickness of 0.3mm.