Evidence Not Sufficient for Routine Skin Cancer Screening

The US Preventive Services Task Force (USPSTF) has determined that there isn’t enough evidence to conclusively state that routine full-body skin cancer screenings by a clinician are safe or effective.

The report published in the July 26 issue ofJAMAis considered an “I statement,” which according to USPSTF means that “the evidence is insufficient to make a recommendation for or against the provision of a preventive service.”

It’s important to note that the USPSTF’s statement is based on rigorous evidence review that weighed the benefits and risks of screening. Although the potential benefits of screening are apparent, the risks may not be. Unnecessary procedures and downstream complications might be reasons to forgo screening in certain patient populations, such as the elderly.

Importantly, the USPSTF noted that no eligible trials have assessed skin cancer morbidity or all-cause mortality associated with visual skin screening.

This isn’t necessarily a vote against visual skin cancer screenings by clinicians. In light of the number of skin cancers diagnosed each year, it’s necessary to understand the importance of daily sun protection and to avoid excessive exposure to UVR in order to decrease the incidence of skin cancer, premature skin aging, and other long-term dermatologic issues.

“The USPSTF recommendations should not be misinterpreted as minimizing the importance of skin cancer,” wrote Eleni Linos, MD, DrPH, and colleagues in a relatedJAMAeditorial. “Instead, the report should motivate [health care providers] to improve the evidence base for identifying groups of people in whom the benefits of screening might outweigh the risks.”

The unwillingness of the USPSTF to make an official recommendation in favor of screening is the latest in a series of studies and statements weighing the importance of skin cancer safety and awareness.

In a study recently published inJAMA Dermatology, investigators from the Northwestern University Feinberg School of Medicine searched “sunscreen” on Amazon.com and selected the top 1 percentile of products as of December 2015 according to average consumer reviews (4 stars or more) and the highest number of consumer reviews.

The researchers discovered that40% of the sunscreensdidn’t meet American Academy of Dermatology (AAD) criteria, which include SPF of 30 or more, broad-spectrum claim, and water or sweat resistance. Particularly, a significant number of the products (30%) that didn’t meet AAD standards didn’t do so because they weren’t actually water or sweat resistant.

According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States. More than 3.5 million cases are diagnosed every year, and in 2012 alone, an estimated 76,250 individuals were diagnosed with malignant melanoma.

The foundation also reported that almost 90% of nonmelanoma skin cancers are associated with excessive exposure to UVR, and up to 90% of the visible dermatologic changes commonly attributed to aging are caused by the sun.

Clinicians can focus onmodifiable behaviorsto help their patients avoid skin cancer in the first place.

For optimal sun safety, clinicians should advise patients to wear a hat and protective clothing, in addition to using sunscreen throughout the entire sun exposure period.

Some general counseling points about sunscreen include:

• Use sunscreen with an SPF of at least 30.
• Use sunscreen that protects against both UVA and UVB light.
• Apply sunscreen to dry skin 15 to 30 minutes before sun exposure.
• Reapply sunscreen every 2 to 3 hours and after sweating or swimming.

Meanwhile, there are several photosensitizing medications that can cause a healthy individual to become more sensitive to the sun, and thus more likely to burn. Patients taking doxycycline, sulfonamides, fluoroquinolones, nonsteroidal anti-inflammatory drugs, thiazide diuretics, furosemide, lamotrigine, antihistamines, or isoniazid should be aware of this risk.