Is histopathological overdiagnosis of melanoma a good insurance for the future?

‘Are we Men or Corporals?’ is a 1955 movie in which the Neapolitan actor Totò (Antonio De Curtis; 1898–1967) set Men (those who work very hard and are basically good and simple individuals) against Corporals (those who use their authority and power to make Men’s life difficult). Medicolegal concerns are nowadays the Corporals of routine histopathology and dermatopathology. It is well known that the false-negative misdiagnosis of melanoma is the most common reason for claims filed against pathologists [1]. Compared with the disastrous consequences of an unrecognized melanoma, re-excision and sentinel node biopsy, which are the standard procedures for a clinically localized, intermediate thickness melanoma, have negligible consequences because of their very low morbidity; therefore, our Corporals have been increasingly addressing their authority and power toward a more or less conscious approach based on ‘defensive overdiagnosis.’ The implicit, albeit obvious, assumption is: better living with a diagnosis of melanoma than dying with a diagnosis of nevus. Needless to say, a ‘defensive overdiagnosis’ automatically translates into a ‘defensive overtreatment.’

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