SKIN CANCER SCREENING
that people with either a history of skin cancer or an increased risk of skin cancer discuss routine screening increments with a doctor.” Conducting RCTs to evaluate skin cancer screening is fraught with challenges. Comparing mortality due to melanoma in screened versus nonscreened individuals would be difficult and costly, requiring a large population and long follow-up interval to demonstrate a correlation. In addition, identifying a control population might be considered unethical, as a subset of individuals with elevated melanoma risk may be randomized into a nonscreening arm. Also, the potential exists for bias or erroneous comparisons between screened and controlled groups if uneven opportunistic screening occurs. There is literature to suggest that risk-based skin cancer screening is warranted and justifiable. Screening could potentially impact early detection of melanoma, resulting in a reduction of morbidity, mortality and cost of treatment. Self-assessment tools could identify high-risk individuals for screening. A skin cancer screening registry could collect data to standardize screening recommendations, implement these recommendations nationwide and monitor outcomes over time. Dermatologists and other healthcare providers already routinely perform skin cancer screening examinations, as part of routine clinical care and through nationwide public health initiatives such as the SPOTMe® program sponsored by the American Academy of Dermatology (AAD).
Melanoma-related deaths, estimated to be around 10,130 in 2016, account for the majority of skin cancer-related deaths. Over the past four decades, melanoma incidence has increased by nearly 200 percent. It is now the fifth most common invasive cancer in men and the seventh in women, with an estimated 76,380 new cases in the U.S. in 2016. About one in 33 men and one in 52 women in the U.S. will develop melanoma during their lifetime. About 7,230 people die from melanoma each year. New treatments for metastatic melanoma, including immunotherapy and targeted therapy, have shown great promise; however, a diagnosis of metastatic melanoma remains grave. These new treatment regimens are resulting in significant contributions to healthcare costs. It is estimated that more than three million people in the United States are diagnosed with nonmelanoma skin cancer each year. Basal cell carcinoma is far more common than squamous cell carcinoma. About 80 percent of nonmelanoma skin cancer is basal cell carcinoma. About 2,000 people die from basal cell and squamous cell skin cancer each year. For other, less common types of skin cancer, about 4,420 people die every year. Skin cancer screening through total body skin examination is arguably the safest and most uncomplicated screening test in medicine, but there is no consensus regarding its benefit or implementation. There are no randomized controlled trials (RCT) proving that screening reduces melanoma mortality. The US Preventive Services Task Force (USPSTF) 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 adults. Aside from the USPSTF, only a few professional organizations offer specific statements or recommendations about skin cancer screening; these include the American Academy of Dermatology (AAD), the American Cancer Society, the American Academy of Family Physicians and the Skin Cancer Foundation. The AAD statement “encourages all members of the public to serve as their own health advocates by regularly conducting skin self-examinations. If an unusual lesion is detected, or if any lesions are changing, itching or bleeding, it is recommended that individuals seek evaluation by a board-certified dermatologist. It is also recommended
Daniel Mosel, MD Greater NE Dermatology Clinic
Johnson MM, Leachman SA, Aspinwall LG, et al. Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy. Melanoma Manag. 2017;4(1):13–37. doi:10.2217/mmt-2016-0022
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