Melanoma In Situ—Getting the Diagnosis and Prognosis Right

In this issue of JAMA Dermatology, Patel and colleagues examine mortality after a diagnosis of melanoma in situ. Melanoma in situ is the earliest stage of melanoma (stage 0) and is localized to the outermost layer of skin (epidermis). It is regarded as a potential precursor lesion to invasive melanoma (stages I to IV), in which melanoma invades the deeper layers of the skin and, in doing so, acquires the potential ability to spread to distant sites, which may ultimately lead to death from melanoma. Nevertheless, melanoma in situ is not an obligate precursor of invasive melanoma, and it is increasingly acknowledged that some lesions diagnosed as melanoma are clinically indolent and will never progress. The latter scenario is often referred to as overdiagnosis of melanoma.

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Luglio 2023

Public Health and Diagnostic Approaches to Risk Stratification for With Melanoma

Melanoma mortality has declined over the past decade, largely due to availability of dramatically more effective treatments of advanced disease, but melanoma remains an important public health problem due to a persistent significant mortality risk as well as morbidity and cost. In this issue, Kashani-Sabet et al report early detection and prognostic assessment recommendations of a large group of experts using a modified Delphi approach. We consider these recommendations from 3 perspectives: the role of risk stratification, the role of gene expression profiling (GEP), and the hierarchy of evidence as it pertains to public health.

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Maggio 2023