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Panel Concludes Whole-body Examinations Should Not Be Standard of Skin Cancer Care
Posted: February 16, 2009
An examination of your entire body should not be the standard of care for finding skin cancer, a panel of experts has concluded. "There is no new direct evidence on the benefits of screening for skin cancer with a whole-body exam by a physician or by self-exam," said Tracy Wolff, MD, a medical officer at the U.S. Preventive Services Task Force, a program of the Agency for Healthcare Research and Quality, and lead researcher on the project. The panel's report was published Feb. 3, 2009, in the Annals of Internal Medicine.
Wolff said that the task force, which reviewed published studies, could not find enough evidence to determine whether detecting skin cancer early reduces deaths from the disease. It also concluded that information was limited about the ability of primary care physicians to perform adequate examinations in the context of usual care. "Therefore, the task force was unable to assess the balance of benefits and harms of screening for skin cancer by primary care physicians or by self-exam and gave this intervention an 'I' grade for insufficient evidence," Wolff said.
As a result, the panel did not change the stance in guidelines put out in 2001 that indicates insufficient evidence exists to recommend for or against routine screening for melanoma, basal cell or squamous cell skin cancer using a total-body skin examination, Wolff said. "Until there is better evidence to say for sure whether screening in the general public is beneficial, primary care clinicians and patients should remain alert for skin lesions that are worrisome for cancer," she said.
Jeffrey C. Salomon, MD, an assistant clinical professor of plastic surgery at Yale University School of Medicine, said that being aware of lesions on your skin is important in finding skin cancer. "Skin cancers can masquerade as benign-appearing lesions," Salomon said. "In any patient with a prior history of skin cancer, I recommend that they self-examine on a regular basis."
If they develop a skin lesion that does not resolve within six weeks, he said, the lesion should be medically evaluated. "Surveillance can identify obvious malignant lesions," Salomon said. "But for many lesions, surgical biopsy will be required to definitively determine if a lesion is benign or malignant. I cannot rely solely on my clinical exam for pathologic diagnosis."
"Every month I see lesions that I thought were benign and on biopsy were malignant, and vice versa," he said. There is no substitute, he said, for a close relationship with a dermatopathologist, a specialist in diagnosing skin biopsies, when dealing with skin lesions. "While most skin cancers have low morbidity and low mortality risks, early diagnosis makes treatment easier, and early biopsy can give both patient and physician peace of mind," Salomon said.