The melanoma epidemic: reality and artefact

Skin watchers have their own equivalent of the Heisenberg uncertainty principle. Just as you can't know exactly both the momentum and the position of a single electron, once you excise a pigmented lesion and know its histology you forfeit the chance of knowing what would have happened if you had left it in situ; progression, metastasis, or even involution are all possible. Removal of pigmented lesions is now one of the commonest surgical procedures and has radically changed the pattern of referrals to dermatologists. Epidemiological studies show a dramatic increase in histologically confirmed melanomas1 and raise the important questions of whether the increase is real or a diagnostic artefact and whether we should reconsider the relation between sun exposure and melanoma. The incidence of melanoma has increased by 3-7% per year from the mid-1950s to the early 1980s.1 2 3 These changes have been seen in both sexes and in a large number of different caucasian communities in both the …