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Kutzner H, Jutzi TB, Krahl D, Krieghoff‐Henning EI, Heppt MV, Hekler A, Schmitt M, Maron RCR, Fröhling S, Kalle C, Brinker TJ. Überdiagnose von Melanomen – Ursachen, Konsequenzen und Lösungsansätze. J Dtsch Dermatol Ges 2020; 18:1236-1244. [DOI: 10.1111/ddg.14233_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Tanja B. Jutzi
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Dieter Krahl
- Privates Labor für Dermatohistopathologie Mönchhofstraße 52 Heidelberg
| | - Eva I. Krieghoff‐Henning
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | | | - Achim Hekler
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Max Schmitt
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Roman C. R. Maron
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Stefan Fröhling
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
| | - Christof Kalle
- Berlin Institute of Health (BIH) und Charité – Universitätsmedizin Berlin
| | - Titus J. Brinker
- Nachwuchsgruppe Digitale Biomarker für die Onkologie (DBO), Nationales Centrum für Tumorerkrankungen (NCT) Deutsches Krebsforschungszentrum (DKFZ) Heidelberg
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Kutzner H, Jutzi TB, Krahl D, Krieghoff-Henning EI, Heppt MV, Hekler A, Schmitt M, Maron RCR, Fröhling S, von Kalle C, Brinker TJ. Overdiagnosis of melanoma - causes, consequences and solutions. J Dtsch Dermatol Ges 2020; 18:1236-1243. [PMID: 32841508 DOI: 10.1111/ddg.14233] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/13/2020] [Indexed: 12/14/2022]
Abstract
Malignant melanoma is the skin tumor that causes most deaths in Germany. At an early stage, melanoma is well treatable, so early detection is essential. However, the skin cancer screening program in Germany has been criticized because although melanomas have been diagnosed more frequently since introduction of the program, the mortality from malignant melanoma has not decreased. This indicates that the observed increase in melanoma diagnoses be due to overdiagnosis, i.e. to the detection of lesions that would never have created serious health problems for the patients. One of the reasons is the challenging distinction between some benign and malignant lesions. In addition, there may be lesions that are biologically equivocal, and other lesions that are classified as malignant according to current criteria, but that grow so slowly that they would never have posed a threat to patient's life. So far, these "indolent" melanomas cannot be identified reliably due to a lack of biomarkers. Moreover, the likelihood that an in-situ melanoma will progress to an invasive tumor still cannot be determined with any certainty. When benign lesions are diagnosed as melanoma, the consequences are unnecessary psychological and physical stress for the affected patients and incurred therapy costs. Vice versa, underdiagnoses in the sense of overlooked melanomas can adversely affect patients' prognoses and may necessitate more intense therapies. Novel diagnostic options could reduce the number of over- and underdiagnoses and contribute to more objective diagnoses in borderline cases. One strategy that has yielded promising results in pilot studies is the use of artificial intelligence-based diagnostic tools. However, these applications still await translation into clinical and pathological routine.
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Affiliation(s)
| | - Tanja B Jutzi
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dieter Krahl
- Private Laboratory for Dermatohistopathology, Mönchhofstraße 52, Heidelberg, Germany
| | - Eva I Krieghoff-Henning
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus V Heppt
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Achim Hekler
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Max Schmitt
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roman C R Maron
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Fröhling
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christof von Kalle
- Berlin Institute of Health (BIH) and Charité-University Medical Center Berlin, Berlin, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology group (DBO), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
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