{"entity":{"id":"idea-prev-melanoma-ai-thick-melanoma-metric","kind":"idea","name":"Judge skin cancer AI by the thick melanomas it prevents, not the thin ones it finds","aka":[],"tldr":"Melanoma diagnoses have soared while deaths barely changed, a sign of overdiagnosis. AI skin apps should be judged on whether dangerous thick melanomas fall, not how many spots they flag.","summary":"Melanoma incidence has risen roughly six-fold in the US since 1975 with much smaller mortality change. AI dermatology tools risk amplifying detection of indolent in-situ lesions. Propose that regulatory and reimbursement evaluation of AI skin triage require thick (over 1 mm) melanoma incidence and biopsy-to-melanoma ratio as endpoints.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":[],"cancers":["melanoma"],"sections":["early-detection"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis","b-ai-validation"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"AI triage tools judged by detection volume increase in-situ diagnoses and biopsies without reducing thick melanoma incidence; tools optimised against thick-melanoma endpoints adopt more conservative operating points.","rationale":"The metric determines the algorithm's threshold.","test":"Cluster RCT of AI triage in primary care with three-year thick melanoma incidence and biopsy counts.","maturity":"speculative","actor":"regulator","cost":"medium","horizonYears":4},"route":"/ideas/idea-prev-melanoma-ai-thick-melanoma-metric/","neighbours":{"cancer":[{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"bottleneck":[{"id":"b-ai-validation","kind":"bottleneck","name":"AI that is built but not validated or deployed","route":"/bottlenecks/b-ai-validation/"},{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}