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Original research
Overdiagnosis in malignant melanoma: a scoping review
  1. Mille Falk Bjørch1,
  2. Emma Grundtvig Gram1,2,
  3. John Brandt Brodersen1,2,3
  1. 1Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  2. 2Primary Health Care Research Unit, Region Zealand, Denmark
  3. 3Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  1. Correspondence to Mille Falk Bjørch, Centre of General Practice, University of Copenhagen Department of Public Health, Copenhagen, Denmark; millefb{at}live.dk

Abstract

Objectives We aimed to systematically identify and scrutinise published empirical evidence about overdiagnosis in malignant melanoma and examine how frequent overdiagnosis of melanoma is and whether this is related to different types of interventions or diagnostic technologies.

Design and setting Empirical studies that discussed overdiagnosis in malignant melanoma were eligible, including qualitative and quantitative studies in any type of population, age group and geographical location. We excluded studies that did not include empirical data, studies that only mentioned ‘overdiagnosis’ without addressing it further and studies that used the term overdiagnosis for cases of misdiagnosis or false positives.

We developed the search strategy in cooperation with an information specialist. We searched five databases on 21 April 2022: MEDLINE, Embase, CINAHL, PsycINFO and Cochrane Library.

This scoping review adheres to The JBI methodology and Prefered Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping reviews (PRISMA-ScR). Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data from the included studies. The data extracted include study characteristics, population details, research question, the context and the study’s main results.

Results Our search resulted in 1134 potentially relevant studies. 35 studies were included: 29 register studies, 3 cohort studies, 1 case–control study, 1 survey study and 1 randomised controlled trial. Most register studies examined trends in melanoma incidence and/or mortality and found a significant increase in incidence between 0.39% and 6.6% annually and a little or no increase in mortality. Three cohort studies and one case–control study showed that skin screening was associated with increased detection of melanoma; especially in situ or thin invasive melanoma. Three studies estimated the degree of overdiagnosis which ranged from 29% to 60%.

Conclusions Epidemiological data suggest a high degree of overdiagnosis in malignant melanoma. Studies that examined the association between skin screening and malignant melanoma all found increased detection of melanomas, mostly thin and in situ melanomas, which raises concern about overdiagnosis.

  • public health
  • dermatology

Data availability statement

No data are available.

http://dx.doi.org/10.1136/bmjebm-2023-112341

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    Data availability statement

    No data are available.

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    Footnotes

    • Twitter @EmmaGrundtvig

    • Contributors MFB and JB contributed to conceptualisation and design of the review. MFB drafted the protocol and EGG and JB provided comments. MFB and EGG assessed references for eligibility and extracted data from included studies. MFB, EGG and JB contributed to the interpretation of data. MFB analysed data and drafted the manuscript. EGG and JB contributed to revisions with important intellectual content. All authors had full access to all data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data. MFB is guarantor.

    • Funding The Lundbeck Foundation has granted a scholarship to finance the salary of the main author Mille Bjørch for the year 2022. The funding source had no role in the design of this review and did not have any role during its execution, analyses, interpretation of the data or decision to submit results.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.