USPSTF: Evidence Lacking for Visual Skin Cancer Exam

The current evidence is insufficient and the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in asymptomatic adults cannot be determined, according to a draft recommendation statement from the U.S. Preventive Services Task Force (USPSTF).

Not only is the evidence lacking that a clinician’s visual exam reduces morbidity or mortality, the USPSTF said it could actually lead to potential harms, including “misdiagnosis and overdiagnosis and the resulting cosmetic and—more rarely—functional adverse effects resulting from biopsy and overtreatment.”
_________________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
The Importance of Full-Body Skin Examination in the Geriatric Population
Geriatric Dermatology: A Generational Approach
_________________________________________________________________________________________________________________________________________________________________________

The USPSTF stresses that the recommendation only applies to asymptomatic adults—people without a history of premalignant or malignant skin lesions. Beyond the scope of the statement include those patients who present with a suspicious skin lesion or are already under surveillance because of a high risk of skin cancer, such as those with a familial syndrome.

As for children and young adults (under age 25) with fair skin, the USPSTF recommends they be counseled about minimizing their exposure to ultraviolet radiation to reduce their risk of developing skin cancer.

Most professional U.S. organizations don’t have specific recommendations about the clinical visual skin cancer screening exam, and little data on clinician practice patterns exist related to skin cancer screening, the USPSTF said, referring to one 2005 survey of U.S. physicians. In this study, 81% of dermatologists, 60% of primary care physicians, and 56% of internists reported performing a full-body visual skin cancer screening exams on adult patients.

This current USPSTF statement reinforces its 2009 recommendation.

The USPSTF will be accepting public comments until Dec. 28, 2015. To share feedback, visit http://www.uspreventiveservicestaskforce.org/Comment/Collect/Index/draft-recommendation-statement168/skin-cancer-screening2. It will issue a final recommendation statement after reviewing the comments.

Any recommendations are independent of the U.S. government, and they shouldn’t be construed as an official position of the AHRQ and HHS, USPSTF noted.

-Mike Bederka

Reference:

U.S. Preventive Services Task Force. Draft Recommendation Statement: Skin Cancer: Screening. November 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement168/skin-cancer-screening2