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Evidence insufficient to make recommendation regarding visual skin examination by a clinician

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The U.S. Preventive Services Task Force (USPSTF) has concluded 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 asymptomatic adults. The report appears in the July 26 issue of JAMA.

This is an I statement, indicating that that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Basal and squamous cell carcinoma are the most common types of cancer in the United States and represent the vast majority of all cases of skin cancer; however, they rarely result in death or substantial morbidity, whereas melanoma skin cancer has notably higher mortality rates. In 2016, an estimated 76,400 U.S. men and women will develop melanoma and 10,100 will die from the disease. To update its 2009 recommendation, the USPSTF reviewed the evidence on the effectiveness of screening for skin cancer with a clinical visual skin examination in reducing skin cancer morbidity and mortality and death from any cause; its potential harms, including any harms resulting from associated diagnostic follow-up; its test characteristics when performed by a primary care clinician vs a dermatologist; and whether its use leads to earlier detection of skin cancer compared with usual care.

The USPSTF is an independent, volunteer panel of experts that makes recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications.

Detection

Evidence is adequate that visual skin examination by a clinician has modest sensitivity and specificity for detecting melanoma. Evidence is more limited and inconsistent regarding the accuracy of the clinical visual skin examination for detecting nonmelanoma skin cancer.

Benefits of Early Detection and Treatment

Evidence is inadequate to reliably conclude that early detection of skin cancer through visual skin examination by a clinician reduces morbidity or mortality.

Harms of Early Detection and Treatment

Evidence is adequate that visual skin examination by a clinician to screen for skin cancer leads to harms that are at least small, but current data are insufficient to precisely bound the upper magnitude of these harms. Potential harms of skin cancer screening include misdiagnosis, overdiagnosis, and the resulting cosmetic and–more rarely– functional adverse effects resulting from biopsy and overtreatment.

Summary

Evidence to assess the net benefit of screening for skin cancer with a clinical visual skin examination is limited. Direct evidence on the effectiveness of screening in reducing melanoma morbidity and mortality is limited to a single fair-quality ecologic study with important methodological limitations. Information on harms is similarly sparse. The potential for harm clearly exists, including a high rate of unnecessary biopsies, possibly resulting in cosmetic or, more rarely, functional adverse effects, and the risk of overdiagnosis and overtreatment.

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(doi:10.1001/jama.2016.8465; the full report is available pre-embargo to the media at the For the Media website)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Note: More information about the U.S. Preventive Services Task Force, its process, and its recommendations can be found on the newsroom page of its website.

Media Advisory: To contact the U.S. Preventive Services Task Force, email the Media Coordinator at [email protected] or call 202-572-2044.

To place an electronic embedded link to this study in your story This link for the study will be live at the embargo time: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.8465

Note: A list of related embargoed content appears below.

Related Content from JAMA and the JAMA Network Journals, Available Pre-embargo at the For The Media website:

JAMA

Screening for Skin Cancer in Adults
Updated Evidence Report and Systematic Review for the U.S. Preventive Services Task Force
Karen J. Wernli, Ph.D., M.S., Group Health Research Institute, Kaiser Permanente Research Affiliates Evidence-based Practice Center, Seattle, and colleagues

Editorial: Visual Inspection and the U.S. Preventive Services Task Force Recommendation on Skin Cancer Screening

Hensin Tsao, M.D., Ph.D., Massachusetts General Hospital, Boston, and Martin A. Weinstock, M.D., Ph.D., Warren Alpert Medical School of Brown University, Providence, R.I.

JAMA Oncology

Editorial: The Case for Skin Cancer Screening With Total-Body Skin Examinations
Vinayak K. Nahar, M.D., M.S., University of Mississippi Medical Center, Jackson, M.S., and colleagues

JAMA Dermatology

Editorial: What the USPSTF 'Insufficient' Skin Cancer Screening Recommendation Means for Primary Care Clinicians and Dermatologists
Susan M. Swetter, M.D., Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif., and colleagues

JAMA Internal Medicine

Editorial: Skin Cancer – The Importance of Prevention
Eleni Linos, M.D., Dr.P.H., University of California, San Francisco, and colleagues

JAMA Patient Page
Screening for Skin Cancer

Media Contact

Media Coordinator
[email protected]
202-572-2044
@JAMA_current

http://www.jamamedia.org

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