Evidence Lacking to Recommend Visual Skin Cancer Screening

More Study Needed to Assess Pros, Cons of Exam, Says USPSTF

December 07, 2015 04:08 pm Chris Crawford

The majority of skin cancers are nonfatal, but the National Cancer Institute estimates that this year alone, 74,000 Americans will be newly diagnosed with melanoma, and more than 9,900 patients will die from the disease.

[Physicians looking through magnifying glass at on mole on woman's shoulder]

On Dec. 1, the U.S. Preventive Services Task Force (USPSTF) released a draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on visual skin cancer screening in asymptomatic adults. The task force noted that it had prioritized screening outcomes for melanoma in developing the statement.

Based on a systematic review, the USPSTF found current evidence to be insufficient to assess the balance of benefits and harms of full-body visual skin exams to detect melanoma or nonmelanoma skin cancer (i.e., basal and squamous cell carcinomas) in these patients -- an "I" recommendation.(www.uspreventiveservicestaskforce.org)

"The task force is dedicated to helping Americans avoid skin cancer and lead healthy lives," said USPSTF member Michael Pignone, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "Until we have more research to better understand the balance of benefits and harms of a clinical visual skin exam, we encourage patients to talk to their doctor about any concerns they have about their skin."

Story Highlights
  • The U.S. Preventive Services Task Force (USPSTF) has released a draft recommendation statement about screening for skin cancer, finding current evidence to be insufficient to assess the balance of benefits and harms of full-body visual skin exams to detect melanoma or nonmelanoma skin cancer in adults.
  • This "I" recommendation updates a 2009 recommendation from the USPSTF that also concluded the evidence at the time was insufficient to assess the balance of benefits and harms "of using a whole-body skin examination by a primary care clinician or patient skin self-examination" to detect skin cancer in the general adult population.
  • The USPSTF will accept comments on the draft recommendation statement and its accompanying draft evidence review through Dec. 28.

Specifically, the task force found that current research on the effectiveness of full-body visual skin cancer screening by a physician was insufficient to link this screening to a reduction in morbidity or mortality.

Additionally, the USPSTF found adequate evidence that visual skin cancer screening by a physician can lead to potential harms, including misdiagnosis and overdiagnosis, with resulting adverse cosmetic results such as scarring and, more rarely, functionally adverse effects.

Update From 2009

The draft recommendation statement updates a 2009 statement from the USPSTF that also concluded the evidence was insufficient "to assess the balance of benefits and harms of using a whole-body skin examination by a primary care clinician or patient skin self-examination" to detect skin cancer in the general adult population.

No statement about patient skin self-examination was included in the new draft recommendation because, the task force explained, the mission of the USPSTF is to provide guidance to physicians about the preventive services they offer in the primary care setting. Therefore, patient visual self-examination was determined to be outside the scope of the current review and would be more appropriately covered in a recommendation statement on physician counseling to prevent skin cancer.

The AAFP's own 2009 recommendation on screening adults for skin cancer also concluded that the evidence available was insufficient to assess the balance of benefits and harms of such screening.

According to a related AAFP policy, the best advice family physicians can give patients -- especially younger patients -- to best protect them against skin cancer continues to be minimizing exposure to ultraviolet rays. This includes reducing the amount of time spent directly in the sun, especially during the peak daylight hours of noon to 3 p.m.

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that skin cancer rates continue to increase throughout the United States. "We need to educate our patients, families and friends about the importance of prevention by using effective sun protection strategies and avoiding indoor tanning," she said.

Up Next

The USPSTF will accept comments on the draft recommendation statement(www.uspreventiveservicestaskforce.org) and its accompanying draft evidence review(www.uspreventiveservicestaskforce.org) through Dec. 28.

The AAFP is reviewing the USPSTF's draft recommendation and will update its own recommendation after the task force publishes its final recommendation statement.

Related AAFP News Coverage
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AAFP Resource Offers Tips for Hydration, Sun Protection and Pool Safety

(5/21/2015)

Lotion of Youth?
Data Show Sunscreen Slows Skin Aging, Reduces Cancer Risk

(6/4/2013)

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