Public comments can be submitted from October 25, 2022, to November 21, 2022, at https://www.uspreventiveservicestaskforce.org/tfcomment.htm.

 More research is needed to recommend for or against screening adolescents and adults without skin cancer symptoms, according to the U.S. Preventive Services Task Force.

The Task Force determined that there is not enough evidence to recommend for or against screening people without symptoms. This is an I statement, meaning that the balance of benefits and harms cannot be determined. For this recommendation, screening is defined as a visual skin exam by a primary care professional. The recommendation does not apply to people with a family history of skin cancer or those with signs or symptoms, such as irregular moles. “In updating our recommendation, the Task Force looked to see if there was any new evidence about the effectiveness of primary care professionals screening for skin cancer,” says Task Force member Katrina Donahue, M.D., M.P.H., in a news release. “Unfortunately, there is not enough evidence to know whether or not screening adolescents and adults without symptoms reduces complications or death, so we are calling for more research.” 

People at increased risk for developing skin cancer include people who have had many sunburns, males, and older people. Use of indoor tanning beds is also an important risk factor, particularly for adolescents and young adults. For melanoma specifically, people at increased risk include those with fair skin, light colored eyes, red or blond hair, and people who have a large number of moles, or a family or personal history of skin cancer. 

It is important to note that this recommendation does not apply to people with a personal or family history of skin cancer or with symptoms, such as irregular moles. “We recognize that skin cancer is a common cancer, however we need more research on the effectiveness of visual skin exams by a primary care professional to screen people without symptoms,” says Task Force member Martha Kubik, Ph.D., R.N. “In the absence of evidence, we encourage healthcare professionals to use their judgment when deciding whether to screen individual patients.”

 While evidence is limited in all people, the Task Force is using this recommendation to draw attention to the need for future research to be reflective of the United States, both in terms of including study populations with a diversity of skin tones and settings where access to healthcare varies. People who have noticed changes to their skin or have concerns about skin cancer should talk to their healthcare professional so that they can get the care they need. It is important that people take actions to protect their skin. 

The Task Force has a separate, related recommendation on counseling to prevent skin cancer that provides additional guidance to primary care professionals and patients. 

The Task Force’s draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website at https://www.uspreventiveservicestaskforce.org. Comments can be submitted from October 25, 2022, to November 21, 2022, at https://www.uspreventiveservicestaskforce.org/tfcomment.htm.

This is not the first time the U.S. Preventative Services Task Force has deemed low-risk skin exams unnecessary, said New York City dermatologist Orit Markowitz, MD. "They have been doing this for various other specialties as well, such as downgrading annual pap smears to limiting the necessity for mammograms," she said. "This especially impacts people who are low-risk – you're only low-risk until you’re suddenly high-risk. Oftentimes the USPSTF’s recommendations are not based on individuals, but rather on the greater cost of overall healthcare."

Plus, the evidence that the USPSTF is evaluating doesn’t always include new technologies, such as DermTech’s non-invasive Smart Sticker, which helps prevent unnecessary biopsies, dermoscopy, confocal microscopy and more, she said. "Additionally, the USPSTF may not be considering how effective dermatologists are at short-term mole monitoring, or how much less money we’re spending and more lives we’re saving when utilizing new technologies."

From a cost perspective, technology like the Smart Sticker, dermascopy and other non-invasive tools allow for fewer expensive biopsies, she added. "From a patient advocacy perspective, these tools enable us to catch things much earlier: Not only are we saving the government money, but we’re also saving lives," she said. "Unfortunately, the USPSTF’s recommendations don’t always take these factors into account – and, more importantly, this will not change if dermatologists don’t start implementing these non-invasive tools and technologies into our practices."

The draft recommendation is available for public comment between now and Nov. 21. "I would advise dermatologists to look at some of the literature that considers the use of non-invasive tools for skin exams," she said. "I would also remind everybody that the USPSTF is not considering this literature when they’re making their recommendations; rather, it’s focusing on more archaic tools. It's unfortunate that they are not more up to date with what is actually available to diagnose and manage patients."

 Melanoma is the number one cause of cancer death for patients in their mid-twenties, and we also know that skin cancer is the most common form of cancer, Dr. Markowitz said. "Annually, there are more cases than breast, colon, lung and prostate cancer combined [and] with this in mind, it’s important to realize the cruciality of skin exams. They are so straightforward compared to exams for other cancers – you simply need your eyes and a few other very affordable tools." 

Disclosures: Dr. Markowitz serves as a consultant DermTech on a case-by-case basis.