The Task Force has concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for skin cancer with a clinical visual skin examination in adults.
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An updated evidence review found scant evidence on either the benefits or harms of a health care professional performing a skin exam as part of a patient’s regular check-up, said Dr. David Grossman.
A report published in CNN revealed, “For years, many dermatologists have urged patients to have a full-body visual check for skin cancer”. A single ecological study (Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany [SCREEN]) with important methodological limitations suggests that a one-time, general population-based screening program (with limited participation of 19%) combined with a disease awareness campaign may result in, at most, one fewer death due to melanoma per 100,000 persons over a decade.
President of the American Academy of Dermatology Dr. Abel Torres noted, however, “the USPSTF is not recommending against skin cancer screenings”. The finding could also encourage health insurance companies not to cover skin-cancer screenings for people who don’t have a history of the disease. It has made recommendations regarding the effectiveness of the services for patients not showing any obvious symptoms or don’t face high risk.
The skin-cancer screening is the latest preventive service to be hotly debated among experts. “We’re pretty clear on what it would take to move this” to a recommendation in favor of regular skin exams. That study showed a almost 50 percent decline in death rates from melanoma in men, and improved melanoma death rates compared with other nearby regions. “It’s unclear whether the drop they saw in mortality is related to the screening or to improved behavioral response, with people using skin protection”, Grossman said. In addition, “that rate wasn’t sustained over time”, he said. While the first two are rarely fatal, melanoma will cause more than 10,000 deaths in 2016, the group said.
Most patients – even those who have already been treated for melanoma, according to research – don’t check their skin thoroughly for problematic growths, wrote a team of dermatologists led by University of MS dermatologist Vinayak K. Nahar.
Nahar and others said that research, which was conducted for a short duration, only screened people for skin cancer in one year, which is likely why it did not save as many lives as it could have.
But the task force does say there are not enough well-conducted studies to establish the practice saves lives without incurring undue risks for patients.
The USPSTF is an independent, volunteer panel of national experts who regularly review the scientific evidence and make recommendations regarding health screening procedures and preventive medicine.
Writing in JAMA Oncology on the Preventive Services Task Force ‘s recommendation, a trio of dermatologists pressed the case for continued screening. The SCREEN study did not report the number of excisions required to prevent one death from melanoma, but it can be estimated at more than 4,000.
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The task force’s statement didn’t deal with self-examination for skin cancer, which it says will be handled in a separate recommendation in the future.
