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Drs Lipsker et al¹ recently reported that in a carefully conducted population-based study there was a dichotomy between the rising incidence of thin melanomas and the stable incidence of thicker lesions. The authors point out that the excision of increasing numbers of thin melanomas has had no effect on the incidence of thick melanomas. They propose as an explanation that thin and thick melanomas have different epidemiological features, and that the increased incidence of this cancer is owing to the recognition of a thin form of melanoma that is innocuous and unlikely to cause death if not treated.

However, there is an alternate interpretation that leads to a different conclusion. It flows from a simple mathematical analysis of the differing impacts of (1) the increasing incidence of melanoma, and (2) early detection on the proportion of patients who will have thin as opposed to thick lesions at diagnosis. It is . . . [Full Text of this Article]