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Dan Lipsker, MD

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In reply

Bystryn states the following: "that the absolute number of thick melanomas is not declining probably simply reflects that they represent a continually smaller proportion of a continually increasing number of melanomas, not that they are a different type of melanoma." I do not agree with this assumption. First, from an epidemiologic point of view, this is highly unlikely. Indeed, according to Bystryn's suggestion, stability in the number of thick melanomas would then mean that the steady improvement in our ability to diagnose this cancer early would have exactly paralleled the actual increase in incidence over a period of 25 years. This is hardly conceivable.

Second, as I stated in my editorial,¹ we now have clinical and biological data to support the existence of different types of melanoma. The fast-growing melanomas lack the classic ABCD criteria (A, asymmetry; B, border irregularity; C, color variegation; D, diameter . . . [Full Text of this Article]

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Fast-Growing and Slow-Growing Melanomas
Giuseppe Argenziano, Iris Zalaudek, and Gerardo Ferrara
Arch Dermatol. 2007;143(6):802-803.
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Increasing Ratio of Thin to Thick Melanoma Lesions: Pathogenesis and Early Detection of This Cancer
Jean-Claude Bystryn
Arch Dermatol. 2007;143(6):804.
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Growth Rate, Early Detection, and Prevention of Melanoma: Melanoma Epidemiology Revisited and Future Challenges
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