Doctors Question Rise in Skin Cancer Biopsies Melanoma, the deadliest form of skin cancer, is diagnosed at more than twice the rate it was just 20 years ago. But some doctors worry this isn't a signal of melanoma epidemic. Instead, it could be an epidemic of skin biopsies.
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Doctors Question Rise in Skin Cancer Biopsies

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Doctors Question Rise in Skin Cancer Biopsies

Doctors Question Rise in Skin Cancer Biopsies

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NPR's Patti Neighmond has this report.

PATRICIA NEIGHMOND: Chrys Uicker never expected to be diagnosed with melanoma, especially at age 33.

NEIGHMOND: I remember exactly what I was doing. I was sitting actually in my home office.

NEIGHMOND: On a hot day in July five years ago, her mother was with her. She and her husband had just become parents for the first time, and her doctor was calling with results of a biopsy from a mole on her leg.

NEIGHMOND: I think he may have asked if I was able to talk and in a good place and of course, you know, my heart started skipping.

NEIGHMOND: Uicker was not high risk for melanoma. She had no family history of the disease. She was not fair-skinned and had always protected herself from the sun with sunscreen.

NEIGHMOND: He said the good news is that we've caught it very early and that we're going to go back in for a deep and wide incision and that, you know, a very good prognosis of a full recovery, and so forth. But all I could hear was that I have cancer.

NEIGHMOND: After that day in July, the sun became Uicker's enemy. She stopped horseback riding, swimming, boating. Her life became a frightening routine of biopsies and surgeries.

NEIGHMOND: It seemed as though every time I went to see the oncologist, he would look me over and find a funny-looking freckle or a funny-looking mole.

NEIGHMOND: And then she'd be referred back to her dermatologist for another biopsy, which was once again sent to the lab.

NEIGHMOND: Then it would come back as some type of diagnosis that would require a follow-up procedure and then based on my history I would have to have a wide incision.

NEIGHMOND: Over five years, Uicker had surgeries to remove parts of her calf, her back, her temple, her toe - all to stop or prevent melanoma. She wanted a second child. The doctors recommended otherwise. The cancer might spread, or even metastasize to the fetus.

NEIGHMOND: I was 33 years old then and my life was kind of - I feel like it just sort of froze. And you know, all the dreams I had built in hoping to have more than one child seemed suddenly impossible. And then on top of that was the fear that now I have this wonderful little girl who's going to be an only child, and probably I'm going to die, and you know, she's going to be alone.

NEIGHMOND: So Uicker and her husband decided to take a chance and have another baby. Luckily, her pregnancy was fine, her baby healthy. Then what Uicker calls her lottery ticket came along. It started with a routine visit to the oncologist, who sent her back to the dermatologist for another biopsy.

NEIGHMOND: And he seemed hesitant about doing the biopsy.

NEIGHMOND: He asked Uicker to sit down. He brought in her charts. Then the question: how would she feel about a second opinion on her case?

NEIGHMOND: And at first I couldn't quite understand what he was talking about. I was kind of registering it with a second opinion on a biopsy on a mole? Well, that's ridiculous. Given the fact that I have melanoma, why wouldn't you? And then I realized he was talking about my whole case.

NEIGHMOND: Two weeks later, Uicker got the second opinion. She never had melanoma. She couldn't believe it.

NEIGHMOND: You know, in my mind you're either pregnant or you're not pregnant. You either have cancer or you don't have cancer. And how can you make such a big mistake?

NEIGHMOND: Dermatopathologist Philip LeBoit says about 10 percent of all skin biopsies are difficult to diagnose. In one study, pathologists completely disagreed on two-thirds of the difficult cases they examined. LeBoit...

NEIGHMOND: I think there is more disagreement about moles and melanoma than other kinds of cancers. The other kinds of cancers don't have as many tricks up their sleeve as the cells that turn into moles and melanomas do.

NEIGHMOND: One of those tricks: benign cells can appear like melanoma, with dark inner nuclei. Another trick: the pattern of cells can be deceptive. On top of that, LeBoit says, biopsies are often taken a lot sooner than with other cancers, meaning the cancer is in earlier stages of growth and therefore more difficult to diagnose.

NEIGHMOND: So we have very early cancers in the skin that are detected at a stage where they're are only a few millimeters across. Whereas even with things like breast cancer, they're seldom detected before they're at least a centimeter and sometimes two centimeters across.

NEIGHMOND: But there was no corresponding increase in biopsies showing later stage melanoma, or in deaths from melanoma. Welch says that suggests doctors are diagnosing melanoma when there's no cancer or when the cancer would never have become deadly.

NEIGHMOND: Whenever we look for cancers in people who have died from something else, we find small, quote, "clinically insignificant cancers" - cancers that people have lived with, they haven't died from. And that reservoir of cancer is something that we're just beginning to tap now as we look harder and harder for cancer.

NEIGHMOND: For example, prostate cancer is often found on autopsy, but it didn't cause the patient's death and might never even have been diagnosed. Doctors are finding similar cases among breast and lung cancers. That's why Welch worries that yearly melanoma screening without a reason for concern might be leading to lots of biopsies and turning lots of healthy people into patients like Chrys Uicker.

NEIGHMOND: I can look back now and see that I suffered a pretty deep depression in the sense that - it's like I lost myself and the person that I was and the person that - carefree and just, you know, I became afraid of dying.

NEIGHMOND: Florida dermatologist James Spencer says lots of people are in that last category.

NEIGHMOND: I will bet you anything that your grandmother did not lie out on by the pool in a bikini with baby oil on. And there's a real good chance that her granddaughter did at some point in the teenage years.

NEIGHMOND: Patti Neighmond, NPR News.

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