Visual skin examination by clinician to screen for skin cancer inadequate: USPSTF recommendation

USA: Skin cancer is the most commonly diagnosed cancer in the U.S. There are different types of skin cancer varying in disease incidence and severity. Basal and squamous cell carcinomas are the most common types of skin cancer but infrequently lead to death or substantial morbidity. Melanomas represent about 1% of skin cancer and cause the most skin cancer deaths.

The U.S. Preventive Services Task Force (USPSTF) has released a recommendation statement for screening for skin cancer. To update its 2016 recommendation, the USPSTF commissioned a systematic review of the benefits and harms of screening for skin cancer in asymptomatic adolescents and adults.

In its recommendation statement, published in JAMA (Journal of the American Medical Association), the task force concludes that the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adolescents and adults. The task force called for further studies more reflective of the U.S. population.

The USPSTF routinely makes recommendations about the effectiveness of preventive care services, and this statement is consistent with its 2016 recommendation.

In a press release, Katrina Donahue, MD, MPH, a task force member, said, "The task force wanted to see if visual skin exams by primary care professionals reduce complications or deaths from skin cancer in people without symptoms. Unfortunately, there is not enough evidence to recommend for, or against screening, and health care professionals should use their judgment when deciding whether or not to screen.”

The document states, "This recommendation applies to asymptomatic adults and adolescents without a history of premalignant or malignant skin lesions. It is not applied to asymptomatic patients, including those with a suspicious skin lesion, or those already under surveillance because of a high risk of skin cancer, such as persons with a familial syndrome (eg, familial atypical mole and melanoma syndrome).

Nora B. Henrickson, an associate investigator at Kaiser Permanente Washington Health Research Institute, and colleagues conducted an evidence review of 29 articles consisting of 6,053,411 people. 

Dr. Henrickson and colleagues noted that all direct evidence on the benefits of screening came from three nonrandomized analyses of population-based skin cancer screening programs in Germany and suggested no population-level benefit for melanoma mortality over 4 to 10 years of follow-up.

Six studies offered inconsistent evidence on the connections between clinician skin examination and lesion thickness or stage at diagnosis. Further, compared with usual care, routine clinician skin examination was not linked to increased detection of skin cancer or precursor lesions (five studies) or stage at melanoma detection (three studies). Similarly, evidence on the connections between clinician skin examination and lesion thickness at detection was inconsistent (3 studies). 

The task force also called for future research more reflective of the United States in terms of both skin tone diversity and settings that reflect disparities in health care access.

Reference:

US Preventive Services Task Force. Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(15):1290–1295. doi:10.1001/jama.2023.4342