USPSTF releases draft recommendation on skin cancer screening in adults, adolescents

The U.S. Preventive Services Task Force has released a draft recommendation stating there is not enough evidence to advocate for or against skin cancer screening in asymptomatic adults and adolescents.

“In updating our recommendation, the Task Force looked to see if there was any new evidence about the effectiveness of primary care professionals screening for skin cancer,” USPSTF member Katrina Donahue, MD, MPH, a professor in the department of family medicine at the University of North Carolina, said in a press release. “Unfortunately, there is not enough evidence to know whether or not screening adolescents and adults without symptoms reduces complications or death, so we are calling for more research.”

The recommendation, an I statement, currently aligns with the USPSTF’s 2016 recommendation on skin cancer screening in adults and does not apply to patients with a family history of skin cancer or to those showing symptoms.

The task force also previously published a separate recommendation in 2018, endorsing behavioral counseling to help reduce skin cancer risk in those aged 6 months to 24 years with fair-type skin.

Skin cancer is one of the most common types of cancer in the U.S., with 427,935 cases (22.7 cases per 100,000) of melanomas of the skin being reported from 2015 to 2019, according to CDC data.

In the draft evidence review, Nora B. Henrickson, PhD, MPH, an associate investigator at Kaiser Permanente Washington Health Research Institute, and colleagues reviewed:

• three studies (n = 1,791,615) on the direct benefits of skin cancer screening;

• two studies (n = 232) on the direct harms;

• nine nonrandomized studies (n = 1,326,051) on the association between stage at skin cancer detection and melanoma mortality or all-cause mortality; and

• six studies (n = 2,947,595) on the association between routine clinician skin examination and stage or lesion thickness at detection.

Progression of melanoma stage at detection was positively associated with an increased risk for melanoma mortality. In one U.S. study (n = 185,219), the adjusted hazard ratio (HR) for melanoma mortality compared with in situ disease at detection was 5.8 (95% CI, 5.3-6.3) for localized, 31.5 (95% CI, 28.9-34.2) for regional and 169.6 (95% CI, 154.2-186.6) for distant stage.

There was a similar pattern for all-cause mortality, according to the researchers. In another study (n = 185,219), the adjusted HR for all-cause mortality was 1.5 (95% CI, 1.5-1.5) for localized, 3.9 (95% CI, 3.8-4.1) for regional and 15.8 (95% CI, 14.9-16.7) for distant.

The researchers found a lack of direct evidence on the benefits of skin cancer screening as well as associations between routine clinician examination and detection of keratinocyte, carcinoma, melanoma or skin cancer precursor lesions.

Henrickson and colleagues also noted that evidence on the persistent harms of screening were “minimal,” listing overdiagnosis, overtreatment, cosmetic and psychological impacts as all hypothesized harms.

According to the USPSTF, those at an increased risk for developing skin cancer include men, older people and those with many sunburns. People with red or blonde hair, fair skin and those with many moles have an increased risk for melanoma, specifically.

The USPSTF noted that despite limited evidence, the task force is using the recommendation to help draw attention to needed research that’s reflective of the U.S. population, which includes individuals with diverse skin tones and in settings where access to health care can vary.

“In the absence of evidence, we encourage health care professionals to use their judgment when deciding whether to screen individual patients,” task force member Martha Kubick, PhD, RN, a professor in the School of Nursing at George Mason University, said in the release.

References:

• Bibbins-Domingo K, et al. JAMA. 2016;doi:10.1001/jama.2016.8465.
• Cancer statistics at a glance. https://gis.cdc.gov/Cancer/USCS/#/AtAGlance/. Accessed Oct. 24, 2022.
• Screening for skin cancer: An evidence update for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/skin-cancer-screening-1. Accessed Oct. 27, 2022.
• U.S. Preventive Services Task Force issues draft recommendation on screening for skin cancer. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/skin-cancer-screening-bulletin.pdf. Published Oct. 25, 2022. Accessed Oct. 25, 2022.