Melanoma In Situ—Getting the Diagnosis and Prognosis Right

JAMA Dermatol. Published online June 7, 2023. doi:10.1001/jamadermatol.2023.1485

In this issue of JAMA Dermatology, Patel and colleagues1 examine mortality after a diagnosis of melanoma in situ. Melanoma in situ is the earliest stage of melanoma (stage 0) and is localized to the outermost layer of skin (epidermis). It is regarded as a potential precursor lesion to invasive melanoma (stages I to IV), in which melanoma invades the deeper layers of the skin and, in doing so, acquires the potential ability to spread to distant sites, which may ultimately lead to death from melanoma. Nevertheless, melanoma in situ is not an obligate precursor of invasive melanoma, and it is increasingly acknowledged that some lesions diagnosed as melanoma are clinically indolent and will never progress.2 The latter scenario is often referred to as overdiagnosis of melanoma.3

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