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Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method
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  • Published on: 22 May 2024
    Re: Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method
    • Anna McNay, President California Society of Dermatology and Dermatologic Surgery (CalDerm)
    • Other Contributors:
      • Melissa Shive, (1) Assistant Clinical Professor; (2) President Elect

    February 28, 2024

    To: Juan VA Franco, MD
    Editor-in-Chief
    British Medical Journal, Evidence-Based Medicine

    Dear Editor:
    The study on cutaneous melanoma overdiagnosis attempts to tackle an important issue. However, we wish to address several methodological concerns that may warrant a critical evaluation of its conclusions.

    First, one key study assumption is that the overdiagnosis of melanoma is due to over-screening by clinicians, including dermatologists. However, whether the patients were actually screened by clinicians is unknowable with the current study design. Thus, the lack of direct evidence to support this key assumption limits the study's capacity to attribute melanoma diagnoses to the prevalence of screening.

    Second, the study's ecological methodology does not sufficiently account for variables that could affect melanoma diagnosis and mortality rate over time, such as advancements in diagnostic technologies, treatments, public awareness, and healthcare access, all factors that dermatologists have worked to improve over time. These factors could independently influence trends in melanoma incidence and mortality. This limitation is critical as it underlines the difficulty in drawing definitive conclusions from the ecological data presented.

    Thirdly, the choice to manually input annual data from the SEER program into the DevCan software, deviating from the standard 3-year data aggregatio...

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    Conflict of Interest:
    None declared.