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JAMA Patient Page
July 26, 2016

Screening for Skin Cancer

JAMA. 2016;316(4):470. doi:10.1001/jama.2016.9817

The US Preventive Services Task Force (USPSTF) has published updated recommendations on screening for skin cancer.

What Is Skin Cancer?

Skin that is exposed to the sun can become damaged, causing skin cells to uncontrollably divide. When this occurs in the skin’s outermost layers, it is known as squamous cell carcinoma. Basal cell carcinoma occurs when the affected cells are just below the squamous cells in the skin. The cells that make the brown pigment melanin, which gives skin its brown color, are called melanocytes, and when they become cancerous, the cancer is called melanoma. Squamous and basal cell cancers spread around the place where they start but usually do not spread to other parts of the body. Melanoma accounts for only 2% of skin cancers but spreads rapidly throughout the body and can cause death. It is best to find and remove these cancers early. It is not known if screening (deliberately looking for these cancers on a regular basis) helps detect melanoma early enough to help people.

What Tests Are Used to Screen for Skin Cancer?

Because skin cancers can be seen by carefully looking at the skin, screening for skin cancer involves having a clinician carefully look at all skin surfaces trying to find cancers. Lesions that look suspicious have some or all of the following characteristics (ABCDE):

  • Asymmetrical (one half is not identical to the other)

  • Borders that are irregular, uneven, or ragged

  • Color that varies from one area to another

  • Diameter that is larger than 6 mm (larger than a pencil eraser)

  • Evolving over time

If you notice any skin lesions that have these features, show them to your physician. Previous JAMA Patient Pages on detecting skin cancer and on melanoma have more information about these cancers and pictures of what some of them look like. Any suspicious lesions should be removed, or a biopsy should be performed by having a clinician remove a piece of the abnormal skin lesion for a pathologist to look at it.

What Is the Patient Population Under Consideration for Screening for Skin Cancer?

The screening recommendation was made for adults who do not have any symptoms associated with skin cancer or any history of premalignant or malignant skin lesions. These screening recommendations do not apply to anyone with a suspicious skin lesion or who has a high risk of skin cancer (people who have skin cancer in their family or who have a skin cancer syndrome).

What Are the Potential Benefits and Harms of Screening for Skin Cancer?

In general, finding cancers early should help people. For many skin cancers, finding and removing them early reduces the amount of skin that needs to be removed, resulting in less scarring or disfigurement. There have not been any definitive studies showing that screening for skin cancer results in helping a substantial number of people.

It is also not clear if screening for skin cancer harms anyone. Most lesions removed or biopsied because they are thought to be skin cancer are not cancer. It is not known if removing these lesions harms anyone.

How Strong Is the Recommendation to Screen for Skin Cancer?

There are no studies definitively showing that screening for skin cancer hurts or helps people.

Bottom Line: Current Recommendation for Screening for Skin Cancer

The USPSTF concludes that the current evidence is insufficient (called an “I” recommendation) to assess the balance of benefits and harms of screening for skin cancer in adults.

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The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Source: US Preventive Services Task Force. Screening for skin cancer: US Preventive Services Task Force recommendation statement. JAMA. doi:10.1001/jama.2016.8465.

Topic: Preventive Medicine

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