Approaching Skin Cancer Screening and Prevention

Submitted by Yara White, MSPAS, PA-C, Savola Aesthetic Dermatology Center

Skin cancer is the most common form of cancer affecting Americans. Although melanoma only accounts for 1% of skin cancers, with basal cell and cutaneous squamous cell carcinomas being the most common, it remains the most deadly. 1 Rates of melanoma have continued to rise over the last 30 years. 2 In the last 10 years the number of new cases annually has increased by 53%. 1 The incidence of melanoma in women ages 18 to 39 increased 800% from 1970 to 2009. 3 Fortunately, the 5-year survival rate is 97% when melanoma is caught at an early stage (Ia). 1

Despite these growing numbers, there are no formal guidelines for skin cancer screenings. The most recent USPSTF statement concluded that “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.” 4 However, as of yet, no randomized control trial has directly evaluated the effectiveness of clinical skin exams for decreasing skin cancer morbidity or mortality. 5 Evidence is sufficient that visual skin exams by a clinician have modest sensitivity and specificity for detecting melanoma. 6

So, how do we translate this into effective preventative care for our patients? Assessing risk factors for skin cancer helps target high-risk patients who would benefit most from skin cancer screenings. Risk factors include UV exposure, including a history of sunburns, intense sun exposure, or tanning bed use. Other risk factors to consider are fair skin that burns easily, immune-suppressing diseases or treatments, a history of skin cancers, 50 or more moles greater than 2 mm, atypical moles or larger moles, and a family history of melanoma. 1

A head-to-toe visual skin exam as part of a patient’s yearly physical exam or referral to a dermatology provider for high-risk patients is adequate. An optimal starting age or interval for screenings is unknown. Patient education on how to reduce risk factors, especially limiting UV exposure, is supported by the latest USPSTF recommendations, down to 10 years old. 7 Encouraging self-exams may also prove effective, as half of melanomas are detected by the patient. 8

In conclusion, it is important to assess patient risk for skin cancer, perform a visual skin exam, or refer to a dermatology provider when deemed appropriate. In addition, educating patients on reducing their risk factors and monitoring their own skin on a regular basis will ultimately help prevent skin cancers and improve outcomes by detecting skin cancers early, when treatment is the most successful.

References

  1. The Skin Cancer Foundation. Skin Cancer Facts and Statistics. Updated May 3, 2018. https://www.skincancer.org/skin-cancer-information/skin-cancer-facts. Accessed July 2, 2018.
  2. American Cancer Society. Key Statistics for Melanoma Skin Cancer. Updated January 4, 2018. https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html. Accessed July 2, 2018.
  3. Reed KB et al. Increasing Incidence of Melanoma Among Young Adults: An Epidemiological Study in Olmstead County, Minnesota. Mayo Clinic Proceedings, 2012; 87(4):328-334.
  4. US Preventive Services Task Force. Final Update Summary: Skin Cancer Screening: US Preventive Services Task Force. September 2016.
    http://www.uspreventiveservicestaskforce.org/PageDocuments/UpdateSummary/Final/skin-cancer-screening2?ds=1ds=skincancer. Accessed July 1, 2018.
  5. Breitbart EW, Waldmann A, Nolte S, et al. Systematic Skin Cancer Screening in Northern Germany. J Am Acad Dermatol. 2012; 66(2): 201-211.
  6. Wolff T, Tai E, Miller T. Screening For Skin Cancer: An update of the Evidence for the US Preventive Services Task Force. Ann Intern Med. 2009; 150(3): 194-198.
  7. Moyer VA. US Preventive Services Task Force. Behavioral Counseling To Prevent Skin Cancer: US Preventive Task Force Recommendation Statement. Ann Intern Med. 2012; 157(1): 59-65.
  8. Ariles, Izquierdo J, Molina-Lopez I, Rodriguez-Lomba E, Marques-Rodes I, Suarez-Fernandez R, Lazaro-Ocharta P. Who Detects Melanoma? Impact of Detection Patterns in Characteristics and Prognosis of Patients with Melanoma. J Am Acad Dermatol. 2016; 75(5): 967-974.