{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:56:22Z","timestamp":1790733382907,"version":"4.1.0"},"reference-count":57,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Melanoma early detection has been widely promoted on the assumption that diagnosing early tumors improves outcomes, but epidemiologic data increasingly challenge this assumption. In fair\u2010skinned populations subjected to intensified surveillance, diagnoses of thin invasive and in\u00a0situ melanomas have risen sharply without corresponding declines in advanced disease or melanoma\u2010related mortality, a pattern consistent with cancer overdiagnosis. Heightened scrutiny preferentially detects biologically indolent melanocytic proliferations that often share clinical and histologic features with genuinely aggressive tumors, revealing the limitations of the traditional benign\u2013malignant binary when applied to subtle melanocytic lesions. Drawing on historical anatomic pathology, particularly Virchow's concept of tumors as quantitative deviations along a continuum rather than discrete entities, we argue that many early \u201cmelanomas\u201d are better understood as risk states than as fully realized malignant disease. The MPATH\u2010Dx framework operationalizes this perspective by mapping melanocytic lesions into probabilistic risk classes linked to recommended management, rather than forcing a categorical melanoma versus nevus distinction. Its updated Version 2.0 simplifies classification and grading of atypia, introduces reproducible cytomorphologic thresholds, and defines a low\u2010risk subset of thin invasive melanomas that may ultimately be reclassified as melanocytic neoplasms with high\u2010grade atypia (low malignant potential). Transitioning from a binary to a risk\u2010based diagnostic paradigm could reduce overdiagnosis and overtreatment, improve communication of uncertainty, and better align clinical, administrative, and legal practices with underlying tumor biology. Such a shift, however, will require reeducation of clinicians, patients, payers, and policymakers, as well as adaptation of coding, registry, and malpractice frameworks to a more nuanced understanding of melanoma risk.<\/jats:p>\n                  <jats:p>\n                    <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                      <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/ijd70651-gra-0001-m.png\">\n                        <jats:alt-text>image<\/jats:alt-text>\n                      <\/jats:graphic>\n                    <\/jats:boxed-text>\n                  <\/jats:p>","DOI":"10.1111\/ijd.70651","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:35:10Z","timestamp":1790692510000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mole or Early Melanoma? Rethinking Early Detection, Overdiagnosis, and the Benign\u2013Malignant Paradigm"],"prefix":"10.1111","volume":"65","author":[{"given":"Raymond","family":"Barnhill","sequence":"first","affiliation":[{"name":"Department of Translational Research Institut Curie and Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9802-4144","authenticated-orcid":false,"given":"Robert A.","family":"Swerlick","sequence":"additional","affiliation":[{"name":"Department of Dermatology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010127\u201010\u2010199711150\u201000010"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1900.24620290004002"},{"key":"e_1_2_10_4_1","unstructured":"\u201cCure for Cancer in Prompt Action: Dr. Bloodgood of Johns Hopkins Declares Elimination Sure at Early Stage \u201d(accessed March 2 2026) New York Times(1924)."},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2101980"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.132.8.881"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17\u20102792"},{"key":"e_1_2_10_8_1","first-page":"253","article-title":"Latent Malignancies at Autopsy: A Little Used Source of Information on Cancer Biology","volume":"112","author":"Tulinius H.","year":"1991","journal-title":"IARC Scientific Publications"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljae372"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38516.649537.E0"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2026.1267"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.med.60.101107.134802"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semdp.2008.07.002"},{"key":"e_1_2_10_14_1","unstructured":"R.Virchow \u201cCellular Pathology as Based Upon Physiological and Pathological History: Twenty Lectures Delivered in the Pathological Institute of Berlin During the Months of February March and April 1858 \u201dTranslated by Frank Chance. 7th American Edition ed. 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