USPSTF Reviews Skin Cancer Screening Recommendations

Not all types of skin cancer have high mortality rates; but for those that do, an updated screening exam is long overdue. In 2016, studies suggest that an estimated 76,400 men and women in the United States will develop melanoma—a deadlier form of skin cancer—and nearly 10,100 will die from the disease. However, the US Preventive Services Task Force (USPSTF) last published a recommendation for the screening of skin cancer in 2009.

The USPSTF recently sought to update these recommendations by examining the effectiveness of screening for skin cancer by using a clinical visual skin examination, the harms this type of test poses to the patient, and whether this tool leads to earlier detection of skin cancer than other care means. The study was published this month in JAMA.

Skin cancer is composed of 2 types: melanoma, which is the deadlier of the 2, and nonmelanoma, which can further be divided into basal and squamous cell carcinoma. Nonmelanoma skin cancer occurs in 98% of skin cancer cases and rarely results in death or substantial morbidity. In examining the potential benefit of skin cancer screening, study researchers discovered that visual skin examination performed by the clinician showed modest sensitivity and specificity for detecting melanoma, though results were inconclusive for demonstrating efficacy in detecting nonmelanoma cancer types.

However, researchers concluded that the overall evidence was insufficient and that finding a balance between the benefits and harms of screening an asymptomatic adult for skin cancer was undetermined. For the benefits of screening for skin cancer, the study evidence was unable to adequately conclude that early detection through visual skin examination reduces mortality or morbidity in the long run. On the other side, the researchers noted that while they cannot fully identify to what magnitude screening harms the patient, they were able to find adequate evidence that visual skin examination could result in the misdiagnosis and over diagnosis of the disease as well as lead to adverse cosmetic events.

The study examined excluded examining adult populations that had family history of the disease, who had suspicious skin lesions, and who had already been at high risk for developing the disease. The USPSTF team warned that individuals are at greater risk for developing skin cancer if they have a fair complexion, use tanning beds, and have a history of sunburns or lesions.

Overall, only 81% of dermatologists, 60% of primary care physicians, and 56% of internists perform full-body visual skin examinations in their adult patients, according to a 2005 study. Examination entails looking at 5 specific factors, such as asymmetry, border irregularity, nonuniform color, diameter greater than 6 mm, and evolving over time.

Because the results were generally inconclusive, the USPSTF team emphasized that further exploration and research into the use of visual skin examination needs to be done in order to fully understand the benefits, harms, and effectiveness of skin cancer screening methods.