Melanoma Screening: The Ethics of Over- and Underdiagnosis

Cutaneous melanoma is the fifth most diagnosed cancer in the United States and the incidence is increasing yearly. At present, population screening for melanoma is not recommended by national guidelines on account of insufficient evidence to assess the balance of benefits and harms. Indeed, there remains significant controversy over whether screening for melanoma via increasing the frequency of routine skin checks leads to tangible long-term health benefits for patients. In this paper, we highlight how skin cancer screening can impose harms such as overdiagnosis and suggest that the principle of non-maleficence should play a greater role in the formulation of screening policies. We also explore the pressing issue of the underdiagnosis of melanoma in particular populations. In so doing, this paper underscores how the ethical duties of non-maleficence and justice must be balanced in current dermatological practice.