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The reported incidence of cutaneous melanoma has risen sharply in many countries in recent decades, mainly due to increased diagnoses of melanoma in situ and small invasive melanoma
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Incidence of invasive and metastatic melanoma and melanoma mortality remained relatively stable
These strategies can also be applied to the diagnosis of severe dysplastic moles, so the diagnostic label and apparent equivalence to melanoma in situ (and associated treatment recommendations) in the MPATH-Dx reporting protocol may also lead to serious concerns for patients and clinicians anxiety
.
We searched and reviewed published evidence to support or reject changes in diagnostic thresholds and/or terminology used for these low-risk melanocytic lesions, and provided a detailed report on our findings
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Three lines of evidence were assessed
The second is evidence on the reliability of the diagnostic criteria for these two types of lesions
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We found 14 replicate studies, 3 of which had a low risk of bias
Third, there is evidence that diagnostic thresholds drift over time, so that even if the same melanocytic lesion was previously judged to be benign, a more "malignant" diagnostic label is now used
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We found that two studies provided evidence for the diagnosis, both of which were at high risk of bias
In conclusion, the sparse natural history evidence suggests that the risk of progression from melanoma in situ to invasive melanoma is uncertain but likely low, while the risk of progression from severe dysplastic nevi to invasive melanoma is negligible
.
These types of lesions may be better conceptualized as risk factors for aggressive melanoma rather than as prodromal symptoms
Source: Semsarian CR, Ma T, Nickel B, Do we need to rethink the diagnoses melanoma in situ and severely dysplastic naevus? Br J Dermatol 2022 Jan 10;
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