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Dermatology

Skin Cancer ScreeningUpdated Evidence Report and Systematic Review for the US Preventive Services Task Force

To identify the key insights or developments described in this article

1 Credit CME

JAMA

Published Online: April 18, 2023

US Preventive Services Task Force

Article Information and Disclosures

Nora B. Henrikson, PhD, MPH^1,2;

Ilya Ivlev, MD, PhD, MBI³;

Paula R. Blasi, MPH^1,2;

Matt B. Nguyen, MPH^1,2;

Caitlyn A. Senger, MPH²;

Leslie A. Perdue, MPH²;

Jennifer S. Lin, MD, MCR²

Author Affiliations

¹Kaiser Permanente Washington Health Research Institute, Seattle, Washington
²Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
³ECRI, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania

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Abstract

Importance Skin cancer is the most common cancer type and is a major cause of morbidity.

Objective To systematically review the benefits and harms of screening for skin cancer to inform the US Preventive Services Task Force.

Data Sources MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from June 1, 2015, through January 7, 2022; surveillance through December 16, 2022.

Study Selection English-language studies conducted in asymptomatic populations 15 years or older.

Data Extraction and Synthesis Two reviewers independently appraised the articles and extracted relevant data from fair- or good-quality studies; results were narratively summarized.

Main Outcomes and Measures Morbidity; mortality; skin cancer stage, precursor lesions, or lesion thickness at detection; harms of screening.

Results Twenty studies in 29 articles were included (N = 6 053 411). Direct evidence on screening effectiveness was from 3 nonrandomized analyses of 2 population-based skin cancer screening programs in Germany (n = 1 791 615) and suggested no melanoma mortality benefit at the population level over 4 to 10 years’ follow-up. Six studies (n = 2 935 513) provided inconsistent evidence on the association between clinician skin examination and lesion thickness or stage at diagnosis. Compared with usual care, routine clinician skin examination was not associated with increased detection of skin cancer or precursor lesions (5 studies) or stage at melanoma detection (3 studies). Evidence on the association between clinician skin examination and lesion thickness at detection was inconsistent (3 studies). Nine studies (n = 1 326 051) found a consistent positive association between more advanced stage at melanoma detection and increasing risk of melanoma-associated and all-cause mortality. Two studies (n = 232) found little to no persistent cosmetic or psychosocial harms associated with screening.

Conclusions and Relevance A substantial nonrandomized evidence base suggests a clear association between earlier stage at skin cancer detection and decreased mortality risk. However, nonrandomized studies suggest little to no melanoma mortality benefit associated with skin cancer screening with visual skin examination in adolescents or adults and no association between routine clinician skin examination and earlier stage at melanoma detection. Evidence is inconsistent regarding whether clinician skin examination is associated with thinner melanoma lesions at detection.

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Article Information

Accepted for Publication: March 4, 2023.

Corresponding Author: Nora B. Henrikson, PhD, MPH, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101 (Nora.b.henrikson@kp.org).

Author Contributions: Dr Henrikson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Henrikson, Ivlev, Blasi, Nguyen, Lin.

Acquisition, analysis, or interpretation of data: Henrikson, Ivlev, Blasi, Nguyen, Senger, Perdue.

Drafting of the manuscript: Henrikson, Ivlev, Blasi, Nguyen.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Henrikson, Nguyen.

Obtained funding: Senger, Lin.

Administrative, technical, or material support: Blasi, Nguyen, Senger, Perdue.

Supervision: Henrikson, Ivlev, Lin.

Conflict of Interest Disclosures: None reported.

Funding/Support: This research was funded under contract 75Q80120D00004, Task Order 75Q80120F32001, from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services.

Role of the Funder/Sponsor: Investigators worked with USPSTF members and AHRQ staff to develop the scope, analytic framework, and key questions for this review. AHRQ had no role in study selection, quality assessment, or synthesis. AHRQ staff provided project oversight; reviewed the report to ensure that the analysis met methodological standards, and distributed the draft for peer review. Otherwise, AHRQ had no role in the conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript findings. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We gratefully acknowledge the following individuals for their contributions to this project: Brandy Peaker, MD, MPH (AHRQ); current and former members of the USPSTF who contributed to topic deliberations; Lisa H Williams, MD (Kaiser Permanente Washington), for content expertise and review of the draft report; and Melinda Davies, MA, and Jill Pope, BA (Kaiser Permanente Center for Health Research), for library and editorial assistance. USPSTF members, peer reviewers, and federal partner reviewers did not receive financial compensation for their contributions.

Additional Information: A draft version of this evidence report underwent external peer review from 3 content experts (Adewole Adamson, MD, MPP [University of Texas Medical School at Austin]; Kiarash Khosrotehrani, MD [University of Queensland Centre for Clinical Research, Australia], and Martin Weinstock, MD, PhD [Brown University]) and 1 federal partner (Centers for Disease Control and Prevention). Comments were presented to the USPSTF during its deliberation of the evidence and were considered in preparing the final evidence review. Dr Henrikson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Editorial Disclaimer: This evidence report is presented as a document in support of the accompanying USPSTF Recommendation Statement. It did not undergo additional peer review after submission to JAMA.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.