03/09/2025
Excizia chirurgicală largă în completarea excizie complete a unui melanom in situ nu este necesară - un pas înainte în a evita supradiagnosticul și supratratamentul. (editorial din JAMA Dermatology)
"Surgery de-escalation is one way to limit harms from overtreatment of melanoma in situ. The case for de-escalation can also be made on the grounds that a large proportion of melanoma in situ might potentially not cause harm if they were left undetected and untreated—that is, they are overdiagnosed.
Detection and treatment of melanoma in situ aims to prevent the development of an invasive melanoma and thereby lower a patient’s risk of melanoma-related morbidity and mortality.
However, the marked increases in diagnosis (and treatment) of melanoma in situ have not been followed by any measurable decrease in invasive melanoma incidence. To the contrary, invasive melanoma incidence has also continued to rise—likely due in part to overdiagnosis of superficially invasive melanomas as well as aging populations.
There is little evidence that early detection efforts have had an impact on melanoma mortality either, with recent decreases in the last decade coinciding with the availability of highly effective drug treatments for advanced-stage melanoma.
Melanoma in situ is now diagnosed as frequently as invasive melanoma in the US and twice as frequently as invasive melanoma in Australia, and population-level analyses estimate that more than 70% of cases in Australia and more than 80% of cases in the US may be overdiagnosed."
