Why the Evidence for Skin Cancer Screening Is Insufficient

Abstract

Question: Can screening with whole-body skin examination decrease the rate of death from melanoma? Background: Skin cancer is the most commonly diagnosed cancer in the United States. Most skin cancers are nonmelanoma cancers, either of the basal cell or squamous cell type. The incidence of melanoma and nonmelanoma skin cancer has been increasing for the past 3 decades. Purpose: To examine the evidence of benefits and harms of screening for skin cancer in the general population. Data Sources: MEDLINE and Cochrane Library searches (from June 1, 1999, to August 9, 2005), systematic reviews, reference lists of retrieved articles, and expert suggestions. Study Selection: English-language studies were selected to answer the following question: does screening of asymptomatic persons with a whole-body examination by a primary care clinician or by self-examination reduce morbidity and mortality from skin cancer? Randomized controlled trials and case-control studies of screening for skin cancer were selected. Data Extraction: All studies were reviewed, abstracted, and rated for quality using predefined United States Preventive Services Task Force criteria. Data Synthesis: No new evidence from controlled studies was found that addressed the benefit of screening for skin cancer with a whole-body examination. Limitations: There is a lack of direct evidence linking skin cancer screening to improved health outcomes. There is limited information on the accuracy of screening by physicians or patients using actual patients and lesions.