Melanoma epidemic: Facts and controversies

The presence of a true melanoma epidemic has been a controversial topic for the past decade. A dramatic increase in the incidence of cutaneous malignant melanoma in developed countries is well documented, but mortality rates have not risen as rapidly. This has generated much discussion about whether there is a true increase in disease, or more of an apparent phenomenon that may be explained by multiple biases and other factors. The increase in incidence may be due to aggressive surveillance with increased detection of melanomas that are histologically worrisome but biologically benign. This argument, however, does not account for increased incidence of both thin and thicker melanomas. The controversy lies in the interpretation of these facts. This contribution reviews epidemiologic studies from the United States and worldwide to summarize the arguments for and against the debate about whether a melanoma epidemic exists.