USPSTF issues neutral statement on skin cancer screenings
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Key takeaways:
- Evidence was inconclusive to support or go against skin cancer screenings for adolescents and adults without symptoms.
- The task force recommends additional studies with more diverse patient populations.
The U.S. Preventive Services Task Force has concluded there is not enough evidence to recommend skin cancer screenings by primary care physicians in adolescents and adults without symptoms.
The insufficient evidence statement — or I statement — updates the U.S. Preventive Services Task Force (USPSTF) 2016 recommendations. Three nonrandomized studies evaluating two skin cancer screening programs were used in the determination.
“The U.S. Task Force reviewed the evidence, and we did not find enough evidence to know whether screening those without signs and symptoms would reduce complications or death from skin cancer, including melanoma,” Katrina Donahue, MD, MPH, professor and vice chair of research at the University of North Carolina at Chapel Hill Department of Family Medicine and USPSTF member, told Healio. “This statement is consistent with our last statement in 2016. We still don’t have enough evidence in this area.”
The task force found inconsistent evidence of early melanoma detection or reduced morbidity in skin cancer screenings, leading members to conclude they can neither recommend nor not recommend the screenings.
Risks that could occur with unnecessary screenings include worrier stress and cosmetic issues such as surgical scarring, according to the USPSTF findings.
The task force recommended further research, including in more diverse population groups, as well as the continuation of counseling programs regarding ultraviolet light exposure.
“We’re calling for improved representation of persons with a diversity of skin tones in research studies to promote prevention, early diagnosis and treatment of skin cancer,” Donahue said.
These recommendations do not include patients who have signs or symptoms of possible skin cancer such as unusual moles or skin lesions. For those individuals, the USPSTF continues to recommend discussing signs and symptoms with a physician.
The JAMA Network published three editorials regarding the USPSTF recommendations in which the authors agreed that U.S.-based population studies are needed for further review and more data is necessary to advance the task force’s recommendations.
Adewole S. Adamson, MD, MPP, assistant professor of internal medicine in the division of dermatology at Dell Medical School at The University of Texas at Austin, wrote that dermatologists should use this recommendation as an opportunity to increase the number and quality of studies regarding screening intervention.
“If progress is not made on these gaps in research, dermatologists will end up back in the same place — disappointed with a fifth I statement. Patients deserve better,” Adamson wrote.
A second editorial by Maryam M. Asgari, MD, MPH, associate professor of dermatology at Harvard Medical School, and Lori Crane, PhD, MPH, professor and associate dean for academic affairs at Colorado School of Public Health, University of Colorado, concurred, writing, “the limited and relatively stagnant base of evidence on which the USPSTF based its recommendation should motivate investigators to improve the evidence base for identifying subgroups in whom the benefits of screening might outweigh risk.”
References:
- U.S. Preventive Services Task Force issues final recommendation on screening for skin cancer. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/skin-cancer-screening. Published April 18, 2023. Accessed April 23, 2023.
- Adamson AS. JAMA Dermatol. 2023;doi:10.1001/jamadermatol.2023.0706.
- Asgari MM, et al. JAMA. 2023;doi: 10.1001/jama.2023.3259
Perspective
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Jeffrey Farma, MD, FACS
The overall conclusions of this study is that there are inconsistent results regarding whether skin examination is associated with earlier (thinner) melanomas at detection, and if skin cancer screening leads to earlier detection and decreased melanoma mortality. This is an evaluation of the best data available.
There is little harm of screening except for potentially overdiagnosis, overtreatment, cosmetic results, increased health dollars related to biopsies and negative psychological effects.
Overall, I do not think this study or evaluation will change current practices. As a surgical oncologist with a specialty in skin cancer, there are high-risk populations that exist in the United States that still warrant closer screening and surveillance with direct skin examination.
The USPSTF found current research demonstrates inadequate evidence for wide-scale screening. In my opinion, we need further clinical trials to look at this for specific populations or risk factors to further stratify screening guidelines.
Patients still need to know that if they have a suspicious skin lesion that is changing, immunosuppression, multiple moles, fair skin, or a strong history of sunburns or UV exposure, they should seek skin cancer screening. They also should seek medical care for any lesion that is changing.
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US Preventive Services Task Force. JAMA. 2023;doi:10.1001/jama.2023.434210.1001/jama.2023.3259.
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