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New Draft Recommendation for Skin Cancer Screening in Adults
The U.S. Preventive Services Task Force (USPSTF) has posted online a new draft recommendation statement regarding screening for skin cancer in adults.
Skin cancer is among the most common cancers in men and women in the U.S. The disease is classified as either non-melanoma skin cancer (NMSC), which includes basal cell and squamous cell cancers, or melanoma skin cancer. NMSC represents the majority of skin cancers (more than 97%) and has low mortality. Melanoma skin cancer is less common than NMSC but has higher mortality and case-fatality rates. The detection of melanoma is the primary focus of skin cancer screening.
In 2009, the USPSTF concluded that the published evidence was insufficient to assess the balance of benefits and harms of screening the adult general population by primary care clinicians or by patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous-cell skin cancer. The 2009 review echoed findings from 2001, in which the USPSTF also concluded that there was insufficient evidence to recommend for or against routine skin cancer screening by whole-body skin examination for early detection of cutaneous melanoma, basal cell cancer, or squamous-cell skin cancer.
For its new recommendation statement, the task force focused on visual skin cancer screening in primary care settings. Thirteen studies met the inclusion criteria.
The investigators again reported that they could make no firm conclusions on skin cancer screening and melanoma mortality based on the evidence reviewed. Results from a single population-based study conducted in Germany suggested that skin cancer screening may be associated with reductions in population-level melanoma mortality rates, but the study did not assess comparisons between exposed and nonexposed individuals.
The investigators also found limited data on the harms of visual screen exams, except for biopsy yields and cosmetic harms. The included evidence suggested that the cosmetic results of shave biopsy are acceptable to most adults.
Further, in the thirteen studies under review, the investigators found that when the ratio of excisions required per malignant melanoma identified was evaluated by type of lesion, age, and sex, younger people (aged less than 35 years) required approximately twice as many excisions of suspicious lesions compared with adults over the age of 64 years. Among young adults, the pretest probability of melanoma is lower than in older adults. These data suggest a potential excess burden of excisions for nonmalignant lesions in younger people participating in community skin cancer screening programs, where the incidence of NMSC and melanoma is lowest, according to the authors.
The authors found consistent evidence that later-stage or thicker lesions at melanoma detection were highly related to an increased risk of melanoma mortality and may be associated with all-cause mortality.
A major limitation of the new review was the lack of rigorous studies on skin cancer screening conducted in the U.S. with an application in primary care or internal medicine settings, the authors pointed out. Few U.S. studies included longitudinal follow-up for cancer outcomes, limiting their applicability. Participants in most screening studies tended to be younger women with a perceived increased risk of skin cancer, even though the incidence of skin cancer is highest in older men.
Source: USPSTF; December 2015.