Patient Population Under Consideration
This recommendation applies to asymptomatic adults who do not have a
history of premalignant or malignant skin lesions. Patients who present
with a suspicious skin lesion or who are already under surveillance
because of a high risk of skin cancer, such as those with a familial
syndrome (eg, familial atypical mole and melanoma syndrome), are outside
the scope of this recommendation statement.
Assessment of Risk
Skin cancer of any type occurs more commonly in men than in women and
among persons with a fair complexion, persons who use indoor tanning
beds, and persons with a history of sunburns or previous skin cancer.
Specific risk factors for melanoma include having a dysplastic nevus
(atypical mole), having multiple (ie, ≥100) nevi, and having a family
history of melanoma.3, 4
Like most types of cancer, the risk of melanoma increases with age; the
median age at diagnosis is 63 years, and the median age at death is 69
years.1
Suggestions for Practice Regarding the I Statement
Potential Benefit of Early Detection and Treatment
Direct evidence to assess the effect of screening with a clinical
visual skin examination on the risk of death from skin cancer is
limited.3
A single ecologic study (Skin Cancer Research to Provide Evidence for
Effectiveness of Screening in Northern Germany [SCREEN]) with important
methodological limitations suggests that a 1-time, general
population-based screening program (with limited participation of 19%)
combined with a disease awareness campaign may result in, at most, 1
fewer death due to melanoma per 100,000 persons over a decade.5
An independent analysis of the SCREEN population found that the
observed melanoma mortality rate returned to preintervention levels
after 5 years of follow-up (Figure).6
Potential Harms of Early Detection and Treatment
Information on the harms of screening is also sparse.3
The majority of suspicious skin lesions excised during screening are
not cancerous; for example, the SCREEN study found that between 20 and
55 excisions were performed to detect 1 case of melanoma, depending on
patient age.7
The SCREEN study did not report the number of excisions required to
prevent 1 death from melanoma, but it can be estimated at more than
4,000. Overdiagnosis and overtreatment—the diagnosis and treatment of
cancer that would never have harmed the patient in the absence of
screening—are other important potential harms. Ecologic evidence
suggests that screening with a visual skin examination results in the
overdiagnosis of skin cancer;8, 9 however, current evidence is insufficient to be reliably certain of the magnitude of this effect.
Current Practice
Contemporary data on clinician practice patterns related to skin
cancer screening are limited. A 2005 survey of US physicians found that
81% of dermatologists, 60% of primary care physicians, and 56% of
internists reported performing a full-body visual skin cancer screening
examination on their adult patients.10
Screening Tests
The clinical visual skin examination assesses skin lesions using the
“ABCDE rule,” which involves looking for the following characteristics:
asymmetry, border irregularity, nonuniform color, diameter greater than 6
mm, and evolving over time.
Screening Interval
The optimal interval for visual skin examination by a clinician to screen for skin cancer, if it exists, is unknown.
Treatment
Treatment of screen-detected melanoma generally involves excision,
with or without lymph node management, depending on the stage at
diagnosis. There are a variety of treatments available for squamous and
basal cell carcinoma (which have excellent cure rates), including
surgical excision, Mohs micrographic surgery, radiation therapy,
curettage and electrodessication, and cryosurgery, among other options.
Other Approaches to Prevention
The USPSTF recommends that children, adolescents, and young adults
aged 10 to 24 years who have fair skin be counseled about minimizing
their exposure to ultraviolet radiation to reduce their risk of
developing skin cancer.11
Useful Resources
The Community Preventive Services Task Force has made a number of
recommendations related to preventing skin cancer through the use of
interventions that target child care centers; outdoor occupational,
recreational, and tourism settings; primary and middle schools; and
communities (available at www.thecommunityguide.org/cancer/index.htmlThis link goes offsite. Click to read the external link disclaimer).