Weighing the Evidence: Are Skin Cancer Screenings Worthwhile?

Patricia Lucey, MD, is a board-certified dermatologist at the Inova Melanoma and Skin Cancer Center. She has a special interest in using screenings and other tools to detect the disease at its earliest stages. Read Dr. Lucey’s profile.

 As a dermatologist with a history of melanoma in my family, I know how important it is to detect skin cancer early. Skin cancer is the most common cancer in the United States, and early detection saves lives.

Knowing that, I was concerned when a panel of experts published a report last month concluding that there wasn’t enough evidence of benefit to recommend visual skin cancer screenings as a preventive service.

Does that mean you can skip the full-body mole check at the doctor’s office? Not so fast. Here’s what the report can tell us about screening for melanoma — and the important details that it leaves out.

Costs and Benefits

The report was published by the U.S. Preventive Services Task Force, a panel of independent medical experts who review evidence about whether or not to recommend particular preventive services in primary care settings. But there are some important factors to consider to fully understand the study’s recommendation:

• The panel’s goal was to provide a cost-benefit analysis of visual skin cancer exams. By law, the services they recommend must be covered by health insurance plans. In this case, the task force found there wasn’t enough evidence that the benefits outweighed the potential cost of screening everyone, regardless of risk. That doesn’t mean, though, that skin cancer screenings don’t have benefits.
• The report found insufficient evidence to recommend visual screenings for all patients by primary care doctors. However, it did not consider the benefit to patients at an increased risk of melanoma, or to patients with skin cancer symptoms or changes to the skin
• The panel looked only at evidence of melanoma outcomes, not at other types of skin cancer. While melanoma is the deadliest form of skin cancer, basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer. Those cancers can also be serious, potentially causing scarring, disfigurement, severe tissue damage and even death.
• Most important, this panel found little evidence to suggest that skin cancer screenings were harmful. The report was absolutely not recommending against skin cancer screenings. Rather, the panel concluded that there wasn’t enough evidence to assess the balance of benefits, harms and costs.

Should I Be Screened?

While the panel didn’t find enough evidence to recommend that primary care doctors should be screening every single patient, they definitely did not conclude that skin cancer screening isn’t important. In fact, skin cancer screenings have been proven to save lives.

Do you need to be checked? Here are some facts to consider:

• One in five Americans develop skin cancer in their lifetime. Melanoma is the most deadly form, but it has a high cure rate if it’s caught before it spreads.
• Many people have an increased risk of skin cancer. Risk factors include:
  • Blonde or red hair
  • Skin that burns easily
  • Very fair skin or light eyes
  • History of blistering sunburns
  • History of tanning bed use
  • More than 50 moles
  • Family history of melanoma
  • Personal history of abnormal moles
  • Moles that have the “ABCDEs”­– Asymmetrical shape, Border irregularity, Color being dark or multi-toned, Diameter greater than 6 millimeters, and Evolving or changing in color, shape or size
  • Other skin lesions that are itching, growing or bleeding
• Skin cancer screenings are quick and easy. They don’t require drawing blood or taking tissue samples. And it’s easy for a doctor to do a quick skin check when you’re in the office for an annual exam or for another reason.
• The American Academy of Dermatology recommends yearly exams by a dermatologist or primary care doctor. Talk to your doctor about whether you should have them more or less frequently depending on your history and risk factors.

I’ve seen firsthand the importance of detecting skin cancer early. To learn more about skin cancer or to schedule an appointment, visit the Inova Melanoma and Skin Cancer Center.