Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma

The conventional narrative states that the steadily rising incidence of melanoma among fair-skinned Caucasian populations during the last decades is caused by excessive UV-exposure. There is, however, no doubt that other factors had a significant impact on the rising incidence of melanoma. Pre-1980...

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Autor principal:	Harald Kittler
Formato:	article
Lenguaje:	EN
Publicado:	Mattioli1885 2021
Materias:	melanoma dermoscopy dermatoscopy pathology Dermatology RL1-803
Acceso en línea:	https://doaj.org/article/59e84ab8dc534b6aa766f00cc2e04171
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spelling	oai:doaj.org-article:59e84ab8dc534b6aa766f00cc2e041712021-11-17T08:27:39ZEvolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma10.5826/dpc.11S1a163S2160-9381https://doaj.org/article/59e84ab8dc534b6aa766f00cc2e041712021-07-01T00:00:00Zhttp://dpcj.org/index.php/dpc/article/view/1797https://doaj.org/toc/2160-9381 The conventional narrative states that the steadily rising incidence of melanoma among fair-skinned Caucasian populations during the last decades is caused by excessive UV-exposure. There is, however, no doubt that other factors had a significant impact on the rising incidence of melanoma. Pre-1980s the clinical diagnosis of melanoma was based on gross criteria such as ulceration or bleeding. Melanomas were often diagnosed in advanced stages when the prognosis was grim. In the mid-1980s education campaigns such as the propagation of the ABCD criteria, which addressed health care professionals and the public alike, shifted the focus towards early recognition. Dermatoscopy, which became increasingly popular in the mid-1990s, improved the accuracy for the diagnosis of melanoma in comparison to inspection with the unaided eye, especially for flat and small lesions lacking ABCD criteria. At the same time, pathologists began to lower their thresholds, particularly for the diagnosis of melanoma in situ. The melanoma epidemic that followed was mainly driven by an increase in the number of in situ or microinvasive melanomas. In a few decades, the landscape shifted from an undercalling to an overcalling of melanomas, a development that is now met with increased criticism. The gold standard of melanoma diagnosis is still conventional pathology, which is faced with low to moderate interobserver agreement. New insights in the molecular landscape of melanoma did not translate into techniques for the reliable diagnosis of gray zone lesions including small lesions. The aim of this review is to put our current view of melanoma diagnosis in historical context and to provide a narrative synthesis of its evolution. Based on this narrative I will provide suggestions on how to rebuild the trust in melanoma diagnosis accuracy and in the benefit of early recognition. Harald KittlerMattioli1885articlemelanomadermoscopydermatoscopypathologyDermatologyRL1-803ENDermatology Practical & Conceptual, Vol 11, Iss S1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	melanoma dermoscopy dermatoscopy pathology Dermatology RL1-803
spellingShingle	melanoma dermoscopy dermatoscopy pathology Dermatology RL1-803 Harald Kittler Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma
description	The conventional narrative states that the steadily rising incidence of melanoma among fair-skinned Caucasian populations during the last decades is caused by excessive UV-exposure. There is, however, no doubt that other factors had a significant impact on the rising incidence of melanoma. Pre-1980s the clinical diagnosis of melanoma was based on gross criteria such as ulceration or bleeding. Melanomas were often diagnosed in advanced stages when the prognosis was grim. In the mid-1980s education campaigns such as the propagation of the ABCD criteria, which addressed health care professionals and the public alike, shifted the focus towards early recognition. Dermatoscopy, which became increasingly popular in the mid-1990s, improved the accuracy for the diagnosis of melanoma in comparison to inspection with the unaided eye, especially for flat and small lesions lacking ABCD criteria. At the same time, pathologists began to lower their thresholds, particularly for the diagnosis of melanoma in situ. The melanoma epidemic that followed was mainly driven by an increase in the number of in situ or microinvasive melanomas. In a few decades, the landscape shifted from an undercalling to an overcalling of melanomas, a development that is now met with increased criticism. The gold standard of melanoma diagnosis is still conventional pathology, which is faced with low to moderate interobserver agreement. New insights in the molecular landscape of melanoma did not translate into techniques for the reliable diagnosis of gray zone lesions including small lesions. The aim of this review is to put our current view of melanoma diagnosis in historical context and to provide a narrative synthesis of its evolution. Based on this narrative I will provide suggestions on how to rebuild the trust in melanoma diagnosis accuracy and in the benefit of early recognition.
format	article
author	Harald Kittler
author_facet	Harald Kittler
author_sort	Harald Kittler
title	Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma
title_short	Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma
title_full	Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma
title_fullStr	Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma
title_full_unstemmed	Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma
title_sort	evolution of the clinical, dermoscopic and pathologic diagnosis of melanoma
publisher	Mattioli1885
publishDate	2021
url	https://doaj.org/article/59e84ab8dc534b6aa766f00cc2e04171
work_keys_str_mv	AT haraldkittler evolutionoftheclinicaldermoscopicandpathologicdiagnosisofmelanoma
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Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma

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