- Total body skin examination (TBSE) is the safest, easiest and possibly most cost-effective screening test for melanoma, but there is no consensus regarding its benefit or implementation.
- The recent review aims to propose rational, risk-based, data-driven guidelines for skin cancer screening.
- These guidelines are meant to serve as a starting point for further discussion and can be modified or refined .
Melanoma is a potentially deadly, aggressive form of skin cancer that is most often evident on the skin's surface.
The safest, easiest and most cost-effective method of screening for melanoma, a deadly form of skin cancer, is through total body skin examination (TBSE). But there are no current national consensus regarding how to implement the procedure or its benefit.
‘The review proposes data-driven, evidence-based guidelines for skin cancer screenings that are consistent with the US Preventive Service Task Force's (USPSTF) guidelines for other cancers and diseases.’
Dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval.
In 2016, there were an estimated 76,380 new cases of melanoma and an average of 10,130 melanoma-related deaths in the U.S. It is the fifth most common invasive cancer in men and the seventh in women.
The average 5-year survival rate is 91.5%, but it varies significantly based on the stage of disease. In the last 40 years, the incidence of melanoma has increased by nearly 200%.
The current screening practice for melanoma in primary care have been reviewed by over 50 leaders from the field of dermatology, as recommended by the US Preventive Service Task Force's (USPSTF) 2016 Draft Recommendation Statement in light of the most recent melanoma epidemiology in order to:
- propose rational, risk-based, data-driven guidelines for skin cancer screening that highlighted risk groups for melanoma and provided full screening recommendations for those individuals
- compare the proposed guidelines to recommendations made by other national and international organizations from Australia, New Zealand, Germany and other countries
The article was led by Sancy Leachman and Mariah Johnson from the OHSU Knight Cancer Institute's Melanoma Research Program at the OHSU School of Medicine (OR, USA).
A key aspect of the perspective article was the detailed analysis of the USPSTF statement and the rationale that lead to it.
A series of questions were raised to assess the guidelines and promote active discourse, including asking why morbidity associated with delayed diagnosis of melanoma was omitted from the USPSTF's risk estimates, whether it was valid to extrapolate the satisfaction results from cosmetic procedures to results from a diagnostic procedure for a cancer; and challenging the methodology behind the sourcing of publications that formed the reasoning behind the statement.
"In many ways, it's surprising that our field is currently without a national consensus for skin cancer screening guidelines for patients without symptoms," stated Sancy Leachman.
"One of the goals of this paper was to propose data-driven, evidence-based guidelines for screenings that are consistent with the USPSTF guidelines for other cancers and diseases. The guidelines are of course just a starting point based on patient data we've reviewed to date, but we've identified a strong need to provide providers with initial recommendations outlining when to recommend screenings to their patients." Leachman added.
"Given the current rates of melanoma diagnoses in the US, it is fascinating to see how the field continues to address screening inadequacies for a cancer with potentially such high mortality rates," commented commissioning editor for Melanoma Management, Sebastian Dennis-Beron. "It has been a pleasure to work with Dr Leachman and her colleagues to develop this timely and thought provoking piece, as to really underline the need to develop evidence-based screening guidelines for melanoma patients, given how vital early detection is for survival".
The new article is published in the Future Science Group (FSG) journal Melanoma Management
- Sancy A Leachman et al. Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy. Melanoma Management; (2017)