The US Preventive Services Task Force (USPSTF) has published updated recommendations on screening for 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.
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.
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).
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.
There are no studies definitively showing that screening for skin cancer hurts or helps people.
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.
Centers for Disease Control and Preventionwww.cdc.gov/cancer/skin/index.htm
US Preventive Services Task Forcewww.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/skin-cancer-screening
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
Livingston EH. Screening for Skin Cancer. JAMA. 2016;316(4):470. doi:10.1001/jama.2016.9817