Letters to the Editor
Study Did not Deliver on its Promise
The study unfortunately did not deliver on its promise (1). Cancer registry data are insufficiently complete. The TNM codes used are comparable only to a degree with numerous TNM classifications used in that time period. The original data of the tumor diagnoses with concrete metric data and Clark levels would be needed to reclassify earlier T-stages into an up-to-date TNM system to enable real comparisons. Otherwise the assignation of earlier TNM data is pure speculation. In addition to T, the N stages have also changed. The tumor size in the T stage does, however, not refer to the diameter—as cited—but the thickness/invasive depth of the tumors. Much speculation also surrounds the causes underlying the changes. Novel treatments are more likely to be used in advanced tumors, which benefit from these—rather than the earlier stages. The effect of skin cancer screening is questionable—since its introduction, has anything changed in terms of the frequency of diagnoses, tumor stages? How many melanomas were detected through screening? Among many of the melanomas we investigate in our practice, very few are screening cases. Many dermatologists when sending in biopsy samples do not send screening specimens, often only with curative intent. Many older people tend to present to dermatology practices more commonly with seborrheic keratoses or basal cell carcinomas. In the context of these consultations, are melanomas also diagnosed as an incidental finding at an earlier stage than in other, younger people who feel otherwise healthy? More concrete data with more unequivocal conclusions and less speculation are desirable and perhaps cannot be obtained from cancer registries for such an important topic.
DOI: 10.3238/arztebl.m2024.0065
Dr. med. Stephan Kühne
Pathologie Magdeburg
pathologie-md@gmx.de
| 1. | Eisemann N, Schumann L, Baltus H, Labohm L, Kraywinkel K, Katalinic A: Longer survival from melanoma in Germany: A registry-based time series study. Dtsch Arztebl Int 2024; 121: 45–51 VOLLTEXT |
