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Skin Cancer, Screening, 2016

* Indicates an old grade definition


Recommendations: Screening for Skin Cancer

  • Skin Cancer: Screening --Asymptomatic adults
    Grade: I
    Specific Recommendations:
      The 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.
  • Rationale:

    Importance

    Skin cancer includes melanoma and basal and squamous cell carcinoma. Basal and squamous cell carcinoma, known together as nonmelanoma skin cancer, are the most common types of cancer in the United States and represent the vast majority of all cases of skin cancer (>98%).1 However, nonmelanoma skin cancer rarely results in death or substantial morbidity (<0.1% of patient deaths are caused by this type of cancer), whereas melanoma skin cancer has notably higher mortality rates.1 For this reason, although a visual skin examination by a clinician will detect all 3 of these cancer types, in understanding the potential benefit of screening, the USPSTF prioritized outcomes related to melanoma in developing this recommendation statement. In 2016, an estimated 76,400 US men and women will develop melanoma and 10,100 will die from the disease.1

    Detection

    Evidence is adequate that visual skin examination by a clinician has modest sensitivity and specificity for detecting melanoma. Evidence is more limited and inconsistent regarding the accuracy of the clinical visual skin examination for detecting nonmelanoma skin cancer.2

    Benefits of Early Detection and Treatment

    Evidence is inadequate to reliably conclude that early detection of skin cancer through visual skin examination by a clinician reduces morbidity or mortality.

    Harms of Early Detection and Treatment

    Evidence is adequate that visual skin examination by a clinician to screen for skin cancer leads to harms that are at least small, but current data are insufficient to precisely bound the upper magnitude of these harms. Potential harms of skin cancer screening include misdiagnosis, overdiagnosis, and the resulting cosmetic and—more rarely—functional adverse effects resulting from biopsy and overtreatment.

    USPSTF Assessment

    The USPSTF concludes that the current evidence is insufficient and that the balance of benefit and harms of visual skin examination by a clinician to screen for skin cancer in asymptomatic adults cannot be determined.

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