The United States Preventive Services Task Force (USPSTF) has updated its 2009 recommendations for skin cancer screening in average risk (people without a history of skin lesions), and again concluded that there is insufficient evidence (an “I” rating) to assess the balance of benefits and harms of screening for skin cancer with a visual skin examination by a health professional. We asked Robert A Smith, PhD, vice president of screening for the American Cancer Society, for his reaction.
“In this update, the USPSTF prioritized outcomes related to melanoma vs. non-melanoma skin cancer, and also did not consider the value of adults performing skin self-examination.
“Skin cancer is the most common cancer diagnosed in adults in the U.S., with an estimated 3.3 million adults diagnosed with basal call and squamous cell cancers, and 76,380 melanoma cases diagnosed in 2016. Basal cell and squamous cell carcinoma are rarely fatal, although if untreated can result in significant morbidity, while melanoma will result in 10,130 deaths in 2016.
“The evaluation of the benefits of skin cancer screening has been challenging due to the absence of robust studies from which to draw clear conclusions about the benefits and harms of skin cancer screening for each of the skin cancers, but particularly melanoma.
“In their update, the USPSTF acknowledged that if sufficiently large randomized controlled trials are not feasible (and they probably aren’t), the alternate, more feasible designs with careful safeguards against bias would be acceptable. Moreover, some of the limitations of existing studies can be attributed to weak interventions and a wide range of quality in screening encounters, which compromise the ability to measure the fullest benefit of screening. Other study design flaws have limited our ability to measure the fullest potential of interventions to reduce melanoma deaths.
“In an accompanying editorial, Tsao and Weinstock point out that an ‘I’ rating is not a statement that there is no benefit from screening, but rather a challenge for the research community to ‘work together in executing well-designed but feasible studies’ to provide the USPSTF with sufficient evidence to determine if skin cancer screening can be recommended to all adults or subsets of adults at higher risk.
“The American Cancer Society does not currently recommend annual skin exams by a clinician. The ACS does recommend that adults become familiar with the appearance of the skin, be alert for new or changing skin growths, and seek prompt evaluation by a physician if a change is observed. The ACS says individuals should take precautions to prevent skin cancers by minimizing skin exposure to intense UV radiation by seeking shade, wearing protective clothing, sunglasses that block UV rays, and by applying broad spectrum sunscreen with a skin protection factor (SPF) of 30 or higher. Sunbathing or indoor tanning is not recommended..”