Do "Incidental Melanomas" Exist? If so, how many are they? High Time to Decide

Abstract

Do "Clinically Insignificant, HIstological MElanoma-Like Lesions" (CIHIMELL) - to wit, merely incidental, looking-like-melanoma lesions devoid of intrinsic malignant potential - exist? The question arises from the fact that, in spite of increased diagnoses of completely excised malignant melanoma (MM) in the last two decades, mortality from advanced metastatic disease has not decreased. After a brief review of the literature, the author proposes that the existence of CIHIMELL could be affirmed through post mortem dermoscopy and histological study of any pigmented lesion, clinically or dermoscopically suspected, of several deceased patients undergoing necropsy for death causes unrelated to MM. Should the cumulative prevalence of merely histological melanomas turn out to be exceedingly high and not commensurable with the current death rates of true MM, the discrepancy would tangibly prove that indolent pigmented lesions with morphological aspect of melanoma do exist. This would clearly introduce difficulties that could satisfactorily be dealt with only through a paradigm shift in melanoma surveillance and diagnosis (which could also allow to add a piece of encouraging uncertainty to the patient-physician relationship). However, it can be expected that such an enterprise would be countered by several vested academic and commercial interests.