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Giornale Italiano di Dermatologia e Venereologia 2004 April;139(2):89-96


language: English, Italian

Improvement of early diagnosis of melanoma in a mediterranean population. The experience of the Florence Melanoma Clinic

Giannotti B., Carli P.

Department of Dermatological Sciences University of Florence, Florence, Italy


Until some years ago, the continuous increase of melanoma incidence as well as the rise of melanoma mortality made real the concept of “melanoma epidemic”, prompting new strategies of prevention. Early diagnosis is the most effective weapon in the fight against melanoma. According to population-based data obtained in the Province of Florence, in the period 1985-1999, we found that mortality showed a significant decreasing trend, with an estimated annual percentage change (EAPC = -3.3% among males; mortality was stable (EAPC= 0.2%) among females. This is - to the best of our knowldege – the first report of mortality reduction in males. It is plausible that such finding has been achieved as consequence of intense early detection activity running in our area. In this field, we have recently investigated the impact of an intensive surveillance programme on subjects with high melanoma risk, i.e. with more than 30 nevi and 3 or more atypical nevi. In a series of 218 subjects, 4 new melanomas - all in situ lesions - were detected after a follow-up period of 3.4 years (range 1-6.5). The standardized incidence ratio, i.e. the ratio between the observed and expected cases of melanoma was 44.1 (95% CI 16.5-117.5). This demonstrates that Italian subjects with large number of nevi have a 40-fold higher risk of developing melanoma. New techniques for non invasive diagnosis of pigmented skin lesions, as dermoscopy, enable us in reaching a more precise lesion’s classification. We showed that the adoption of dermoscopy during screening is associated with a reduction of false positive rates, i.e. the number of unnecessary excisions decided for diagnostic verification. Nevertheless, clinicians should be alerted that not even dermoscopy provides 100% accuracy: the risk of false negative melanoma diagnosis - a wrong reassurance in a clinically equivocal lesion - should be always kept in mind.

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