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Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method
  1. Adewole S Adamson1,
  2. Geetanjali Naik2,
  3. Mark A Jones3,
  4. Katy JL Bell4
  1. 1Department of Internal Medicine (Division of Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
  2. 2The University of Texas Health Science Center at Houston, Houston, Texas, USA
  3. 3Institute for Evidence-based Healthcare, Bond University, Gold Coast, Queensland, Australia
  4. 4Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Adewole S Adamson, Department of Internal Medicine (Division of Dermatology), The University of Texas at Austin Dell Medical School, Austin, TX 78701, USA; adewole.adamson{at}


Objectives To quantify the proportion of melanoma diagnoses (invasive and in situ) in the USA that might be overdiagnosed.

Design In this ecological study, incidence and mortality data were collected from the Surveillance, Epidemiology and End Results 9 registries database. DevCan software was used to calculate the cumulative lifetime risk of being diagnosed with melanoma between 1975 and 2018, with adjustments made for changes in longevity and risk factors over the study period.

Setting USA.

Participants White American men and women (1975–2018).

Main outcome measures The primary outcome was excess lifetime risk of melanoma diagnosis between 1976 and 2018 (adjusted for year 2018 competing mortality and changes in risk factors), which was inferred as likely overdiagnosis. The secondary outcome was an excess lifetime risk of melanoma diagnosis in each year between 1976 and 2018 (adjusted and unadjusted).

Results Between 1975 and 2018 the adjusted lifetime risk of being diagnosed with melanoma (invasive and in situ) increased from 3.2% (1 in 31) to 6.4% (1 in 16) among white men, and from 1.6% (1 in 63) to 4.5% (1 in 22) among white women. Over the same period, the adjusted lifetime risk of being diagnosed with melanoma in situ increased from 0.17% (1 in 588) to 2.7% (1 in 37) in white men and 0.08% (1 in 1250) to 2.0% (1 in 50) in white women. An estimated 49.7% of melanomas diagnosed in white men and 64.6% in white women were overdiagnosed in 2018. Among people diagnosed with melanomas in situ, 89.4% of white men and 85.4% of white women were likely overdiagnosed in 2018.

Conclusions Melanoma overdiagnosis among white Americans is significant and increasing over time with an estimated 44 000 overdiagnosed in men and 39 000 in women in 2018. A large proportion of overdiagnosed melanomas are in situ cancers, pointing to a potential focus for intervention.

  • Dermatology
  • Early Diagnosis
  • Health Services Research

Data availability statement

Data are available in a public, open access repository. All data used is publicly available and de-identified.

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Data availability statement

Data are available in a public, open access repository. All data used is publicly available and de-identified.

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  • Twitter @adeadamson, @KatyJLBell

  • Contributors AA, GN, MJ and KB conceived and designed the study and took responsibility for the integrity of the data and the accuracy of the data analysis. AA and GN drafted the manuscript. GN and MAJ did the analysis. AA, GN, MJ and KB critically revised the manuscript for important intellectual content and gave final approval for the version to be published. AA, GN, MJ and KB agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AA, GN, MJ and KB had full access to all the data in the study and had final responsibility for the decision to submit for publication. AA is responsible for the overal content as the guarantor.

  • Funding AA is supported by the Robert Wood Johnson Foundation through The Harold Amos Medical Faculty Development Programme. KB is supported by an Australian Government National Health and Medical Research Council (NHMRC) Investigator Grant (1174523).

  • 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.