Many years ago I had a primary care doctor who used to perform a total body skin examination (TBSE) on me every year as part of my annual exam.
Of course, those all-inclusive physicals are a thing of the past. I haven’t had a physician perform a TBSE for a long time.
I often wondered about that. A TBSE seems like a relatively easy and harmless way to quickly screen for skin cancer. The goal, of course, is to find a melanoma, the deadly skin cancer, when it’s small and possibly curable.
But the go-to source for screening guidelines, the United States Preventive Services Task Force (USPSTF), in 2009 stated there was “insufficient evidence” to recommend either for or against skin cancer screening. In other words, the benefits (finding that rare melanoma early) did not clearly outweigh the risks (time, cost, possible unnecessary biopsy or other treatment).
No clear skin cancer screening guidelines
Last week, the USPSTF, after reviewing new research studies, published its latest recommendation on skin cancer screening:
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.
So no change.
What the task force was looking for was compelling evidence that annual TBSEs saved lives by decreasing the number of deaths caused by melanoma. Because it didn’t find that evidence, the recommendation again came back as an “I” grade, or insufficient evidence.
A “D” or “F” grade means a screening test results in more harm than benefit; an “A” or “B” grade is the opposite.
An “I” grade leaves it to the doctor and patient to talk about how often skin cancer screenings should be done.
The American Cancer Society (ACS) doesn’t offer screening guidelines, either, although it does encourage primary care providers to periodically (not necessarily every year) check for skin cancers on their adult patients.
Talk to your doctor
I appreciate what the USPTF does, and as I wrote about in a previous post, it’s a pretty thankless job because there’s a lot of debate about screening tests in general, and different medical specialties have differing opinions.
Most doctors are in favor of screenings that fall under their particular specialty; dermatologists, understandably, might disagree with the USPSTF’s skin cancer screening recommendation.
The incidence of melanoma, one of the most deadly skin cancers, is increasing faster than any other preventable cancer in the United States. These statistics highlight the importance of skin cancer prevention and early detection efforts, which can save lives and health care dollars. In addition to broad-based patient education, early detection is best accomplished with routine TBSEs performed by health care professionals.
Talk to your health care provider about your personal risk of skin cancer and how often you should have your skin examined.
The following resources have excellent information about risk factors, as well as how to do a self examination and how to determine if a mole should be seen by a doctor.
- The American Cancer Society: Skin Cancer and Early Prevention
- The American Academy of Dermatology: Spot Skin Cancer
- The Mayo Clinic: Skin Cancer
- The Centers for Disease Control (CDC): Basic Information About Skin Cancer
In general, people with fair skin, blue eyes and red hair are at higher risk, as are those with a strong family history of skin cancer.