Perspectives of United States dermatologists on melanoma screening and overdiagnosis: a qualitative study

Early detection efforts in melanoma by dermatologists have led to a rising incidence of localized melanoma without a corresponding decrease in late-stage disease or mortality, raising concerns about overdiagnosis. However, little is known about dermatologists' perspectives on melanoma screening and overdiagnosis.

To explore US dermatologists' views on melanoma screening and overdiagnosis and whether information about overdiagnosis should be communicated to patients and the public.

Data were collected from semistructured qualitative interviews (n = 15) of US board-certified dermatologists recruited via two email listservs (local and national). Interviews were conducted from January to April 2024. We performed a thematic analysis from qualitative interviews.

Dermatologists [8 woman (53%) and 7 (47%) men, all of whom were non-Hispanic (n = 15) and 10 (67%) of whom were White; mean (SD) age 43.7 (7.6) years] described the benefits of melanoma screening, including early detection, patient education and reassurance. They also reported potential psychological, physical and economic harms of melanoma screening. Many dermatologists felt that the harms of screening did not outweigh the potential benefit. They acknowledged melanoma overdiagnosis as a phenomenon but thought that it mostly happened in other clinician practices due to excessive biopsies, and that a main source of the phenomenon was pathologists who overinterpret histological slides. Dermatologists expressed uncertainty and hesitation about discussing overdiagnosis with patients and the public.

US dermatologists recognized the benefits and harms of melanoma screening, with many believing that the potential benefits outweighed the harms. While overdiagnosis was acknowledged as a concern at the population level, most dermatologists did not perceive it as a significant issue in their own practices or view themselves as contributors to the problem. Instead, they attributed overdiagnosis primarily to pathologists' diagnostic decision-making. Furthermore, dermatologists were reluctant to discuss the potential harms of melanoma screening, including overdiagnosis, with patients or the public, especially without the backing of a professional organization. This reluctance has important implications for shared decision-making, informed consent in melanoma screening and efforts to address melanoma overdiagnosis.