Screening for Skin Cancer: Not Enough Data, Says USPSTF

Pam Harrison

October 25, 2022

The US Preventive Services Task Force (USPSTF) has once again concluded that there is insufficient evidence to determine the balance between the benefits vs the harms of clinicians screening asymptomatic adolescents and adults for skin cancer.

This conclusion is the same as in 2016, when the USPSTF last assessed the issue.

"After reviewing the evidence on whether screening for skin cancer in primary care improves people's health, the Task Force found that more research is needed before it can recommend for or against screening," the group stated.

This is a draft recommendation and was published online October 25 on the Task Force website. It will be open for public comment until November 2.

"In updating our recommendation, the Task Force looked to see if there was any new evidence about the effectiveness of primary care professionals screening for skin cancer," commented Katrina Donahue, MD, MPH, professor and vice-chair of research, University of North Carolina at Chapel Hill, who is a member of the Task Force.

"Unfortunately, there is not enough evidence to know whether or not screening adolescents and adults without symptoms reduces complications or death, so we are calling for more research," she added in a statement.

Currently, no professional organization in the US recommends clinical visual examination for skin cancer screening, although the American Academy of Dermatology does provide resources for clinician members to hold free skin cancer screening events for the public.

Benefits vs Harms

For this latest review, Task Force members evaluated more than 20,000 abstracts and over 500 articles to assess the potential benefits vs the harms of clinicians screening asymptomatic patients for skin cancer.

Three nonrandomized trials evaluated the association between melanoma mortality and skin cancer screening over 4 to 10 years of follow-up. For example, at 10 years, the Skin Cancer Research to Provide Evidence for Effectiveness of Screening in North Germany (the SCREEN study) suggested there was no mortality benefit to routine skin cancer screening.

Similarly, no mortality benefit was observed on the basis of national population statistics during a 5-year follow-up of the German National Screening Program.

On the other hand, another nonrandomized study of melanoma mortality among patients who had been documented to have undergone skin cancer screening through a German health insurance initiative did find an absolute decrease in mortality, suggesting a screening benefit at 4 years of follow-up. "Evidence on the persistent psychosocial or cosmetic harms of screening was minimal," the authors continue.

Overdiagnosis and subsequent overtreatment represent potential harms of skin cancer screening, but no direct evidence of this was available, the Task Force members point out.

Routine clinician skin examination is not associated with increased detection of either keratinocyte carcinoma (which includes basal and squamous cell carcinoma), melanoma, or skin cancer precursor lesions compared with usual care or lesion-directed examination, they noted.

"In the absence of evidence, we encourage healthcare professionals to use their judgment when deciding whether to screen individual patients," Martha Kubik, PhD, professor of nursing, College of Health and Human Services, George Mason University, Fairfax County, Virginia, said in the statement.

Task Force members emphasize that the current recommendation does not apply to patients who have a personal or family history of skin cancer or those with at-risk features, such as irregular moles.

They also point out that the Task Force has issued a separate, related recommendation on counseling patients to prevent skin cancer that provides additional guidance for all.

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