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Summary of Recommendation and Evidence

The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin examination by a primary care physician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population (Table 1). I statement.

PopulationAdult general population*
I statementNo recommendation because of insufficient evidence
Risk assessmentSkin cancer risks include family history of skin cancer and considerable history of sun exposure and sunburns
Groups at increased risk of melanoma:
  • • Fair-skinned men and women older than 65 years

  • • Patients with atypical moles

  • • Patients with more than 50 moles

Screening testsThere is insufficient evidence to assess the balance of benefits and harms of whole-body skin examination by a primary care physician or patient skin self-examination for the early detection of skin cancer.
Suggestions for practicePhysicians should remain alert for skin lesions with malignant features that are noted while performing physical examinations for other purposes. Features associated with increased risk of malignancy include asymmetry, border irregularity, color variability, diameter greater than 6 mm (ABCD criteria), or rapidly changing lesions. Suspicious lesions should be biopsied.
Other relevant recommendations from the USPSTF and the U.S. Task Force on Community Preventive ServicesThe USPSTF has reviewed the evidence for counseling to prevent skin cancer. The recommendation statement and supporting documents can be accessed at http://www.ahrq.gov/clinic/uspstf/uspsskco.htm.
The U.S. Task Force on Community Preventive Services has reviewed the evidence on interventions to reduce skin cancer. The recommendations can be accessed at http://www.thecommunityguide.org.

Rationale

Importance. Skin cancer—basal cell carcinoma, squamous cell carcinoma, and melanoma—is the most commonly diagnosed cancer. Although melanoma accounts for about 5 to 6 percent of skin cancer diagnoses, it accounts for approximately 75 percent of the mortality from skin cancer.1

Detection. There is fair evidence that screening by physicians is moderately accurate in detecting melanoma. The evidence is insufficient to determine the extent to which screening by patient self-examination accurately detects skin cancer.

Benefits of detection and early treatment. The evidence is insufficient (lack of studies) to determine whether early detection of skin cancer reduces mortality or morbidity from skin cancer. This is a critical gap in the evidence.

Harms of detection and early treatment. The evidence is insufficient (lack of studies) to determine the magnitude of harms from screening for skin cancer. Potential harms of screening for skin cancer include misdiagnosis, overdiagnosis, and the resultant harms from biopsies and overtreatment. This is a critical gap in the evidence.

USPSTF assessment. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for skin cancer by primary care physicians or by patient skin self-examination. If this service is used, patients should be made aware of the uncertainty about the balance of benefits and harms.

Clinical Considerations

Patient population. This recommendation applies to the adult general population without a history of premalignant or malignant lesions. The USPSTF did not examine the outcomes related to surveillance of patients at extremely high risk, such as those with familial syndromes (e.g., familial atypical mole and melanoma syndrome).

Suggestions for practice regarding the I statement. Physicians should remain alert for skin lesions with malignant features noted in the context of physical examinations performed for other purposes. Asymmetry, border irregularity, color variability, diameter greater than 6 mm (ABCD criteria), or rapidly changing lesions are features associated with an increased risk of cancer. Biopsy of suspicious lesions is warranted.

Assessment of risk. Physicians should be aware that fair-skinned men and women older than 65 years, patients with atypical moles, and those with more than 50 moles constitute known groups at substantially increased risk of melanoma. Other risk factors for skin cancer include family history and a considerable history of sun exposure and sunburns. Benefits from screening are uncertain, even in high-risk patients.

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