Is overdiagnosis of melanoma occurring in Scotland?
Project reference: RAS-24-115
Approval date: 2 May 2025
|
Lead organisation |
Principal Investigator |
|---|---|
| NHS Lothian | Richard Weller |
Lay summary
There is a growing body of evidence that substantial melanoma overdiagnosis is occurring in the rich world, driven by diagnostic scrutiny. Melanomas are being identified, which if they had not been found would not have led to death. We will look for any evidence of this in Scotland.
We have had a tripling in dermatologist numbers- and melanoma diagnoses- in the last 25 years in Scotland, but no rise in mortality. This apparent 'epidemic' has led to the USOC pathway where possible skin cancer is prioritised above all else, and waiting lists for non USOC referrals are as a result at record high levels.
We will draw melanoma incidence, stage and mortality data from SMR06, and outpatient attendance and procedures (as a proxy for diagnostic scrutiny) from SMR00. The focus of the project is to identify whether there is a real rise in potentially lethal melanoma, or a pseudo-epidemic caused by increased scrutiny. This will inform policy on the best balance of dermatology activity.
Public benefit statement
This research aims to determine if the current approach to diagnosing melanoma in Scotland is leading to overdiagnosis. This would mean that cancers are being diagnosed and treated, that would never have caused any harm, leading to unnecessary anxiety, invasive procedures, and a strain on healthcare resources.
Currently, a large proportion of dermatology appointments focus on investigating potential melanoma cases. This high volume of investigations may be diverting resources from other important dermatological conditions.
If we find evidence of overdiagnosis, it could help us:
- Re-prioritise dermatology services: By identifying and potentially reducing unnecessary treatment, we can free up resources for other conditions requiring urgent attention, improving overall dermatological care.
- Reduce patient anxiety: Overdiagnosis can cause significant anxiety and distress for patients. This research will help us understand the true extent of the problem and explore ways to reduce the number of unnecessary diagnoses.
- Improve NHS resource allocation: By focusing on the most effective strategies for preventing and treating life-threatening melanoma, we can ensure that healthcare resources are used efficiently and effectively to benefit the greatest number of people.
This research has the potential to significantly improve the delivery of dermatology services in Scotland, ensuring that resources are used wisely and that patients receive the most appropriate care. We would aim to communicate and disseminate the findings of this research through publication and presentation at dermatology conferences in Scotland, with the hope of influencing policy regarding melanoma diagnostic practices in interest of public benefit.
Datasets used