Malignant melanoma: how error amplification by screening creates spurious disease.

Area of Science:

• Oncology
• Dermatology
• Pathology
• Medical Diagnostics

Background:

• Increased melanoma incidence with stable mortality suggests diagnostic issues.
• Previous explanations focused on histopathological reclassification (diagnostic drift).
• A novel artefact, 'error amplification by screening,' is now proposed.

Purpose of the Study:

• To introduce and define the 'error amplification by screening' artefact.
• To explain how this artefact contributes to the increased incidence of melanoma.
• To assess the potential impact of this artefact on other cancer screening programs.

Main Methods:

• Theoretical analysis of histopathological error in borderline malignancy diagnosis.
• Modeling the effect of screening on the amplification of diagnostic errors.
• Review of existing data on diagnostic reproducibility and screening numbers.

Main Results:

• Error amplification by screening is an inevitable consequence of uneven histopathological error.
• This artefact causes overdiagnosis of malignancy to outweigh underdiagnosis, especially in screening settings.
• The magnitude of the artefact depends on diagnostic reproducibility and screening volume.

Conclusions:

• Error amplification by screening offers a new explanation for rising melanoma incidence.
• This artefact challenges the role of ultraviolet radiation as the sole cause for increased melanoma rates.
• The artefact may be a significant source of misdiagnosis in various cancer screening programs.