Screening for Skin Cancer in Adults

Abstract

OBJECTIVE: To provide an updated systematic review for the US Preventive Services Task Force regarding clinical skin cancer screening among adults(2016) RESULTS: No randomized clinical trialswere identified. Therewas limited evidence on the association between skin cancer screening and mortality. A German ecologic study (n = 360288) found a decrease of0.8 per 100000melanoma deaths in a region with population-based skin cancer screening compared with no change or slight increases in comparison regions. The number of excisions needed to detect 1 skin cancer from clinical visual skin examinations varied by age and sex; for example, 22 forwomen 65 years or older compared with 41 forwomen aged 20to 34 years. In 2 studies of performing visual skin examination, sensitivity to detect melanomawas 40.2%and specificitywas 86.1%when conducted by primary care physicians (n = 16383). Sensitivitywas 49.0%and specificitywas 97.6%when skin examinationswere performed by dermatologists (n = 7436). In a case-control study of melanoma (n = 7586), cases diagnosed with thicker lesions (>0.75mm) had an odds ratio of0.86 (95%CI,0.75-0.98) for receipt of a physician skin examination in the prior 3 years compared with controls. Eight cohort studies (n = 236 485) demonstrated a statistically significant relationship between the degree of disease involvement at diagnosis and melanoma mortality, regardless of the characterization of the stage or lesion thickness. Tumor thickness greater than 4.0mmwas associated with increased melanoma mortality compared with thinner lesions, and late stage at diagnosiswas associated with increased all-cause mortality. CONCLUSIONS