Doctors not sure we all need routine skin cancer screening

(Reuters Health) - There isn’t enough evidence yet to say whether routine full-body skin cancer screenings are safe or effective, according to U.S. guidelines aimed at preventing deaths from these malignancies.

The conclusion, issued today by the U.S. Preventive Services Task Force (USPSTF), adds to an ongoing debate in the medical community about how to strike the right balance between catching dangerous tumors as early as possible and avoiding unnecessary tests and treatments that may result from catching too many harmless abnormalities.

“At this time, the task force concluded that there is not enough evidence to know whether a full-body skin exam by a clinician reduces deaths from melanoma,” said Dr. Michael Pignone, a task force member and researcher at the Dell Medical School at the University of Texas at Austin.

“We do know that there are potential harms, including over-diagnosis and unnecessary treatments that can lead to undesirable cosmetic results,” Pignone added by email.

The vast majority of skin cancers don’t result in death. But melanoma – a rare form that accounts for less than 2 percent of cases – has a much higher death rate.

This year, an estimated 76,400 people will develop melanoma in the U.S. and 10,100 will die from the disease, the task force notes in recommendations published in JAMA.

Screening may make sense for adults with a history of skin cancer or symptoms that point to the potential for melanoma, such as an abnormal mole that is changing in size, shape or color. But other people might be harmed by screening if it results in unnecessary biopsies, scarring or damage that can affect feeling or range of motion, the task force concludes.

The USPSTF, a government-backed independent organization that reviews medical evidence, last updated its skin cancer screening guidelines in 2009.

Then, as now, the task force found too little evidence to weigh in for or against routine screening of all adults. These guidelines are widely used to determine whether insurance will pay for screenings and treatments and are widely followed by primary care physicians.

“It is important for the public to understand that the USPSTF is not recommending against skin cancer screenings,” said Dr. Abel Torres, president of the American Academy of Dermatology.

“Additionally, the public should know that this recommendation does not apply to individuals with suspicious skin lesions and those with an increased skin cancer risk, and it does not address the practice of skin self-exams,” Torres, who wasn’t involved in the task force, said by email.

In a shift from the 2009 guidelines, the task force has eliminated recommendations that patients do self-exams. This guidance might make sense to include in recommendations related to counseling patients about skin cancer, which screening guidelines aren’t meant to address, the task force noted.

SOURCE: JAMA, online July 26, 2017.