Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy

Mariah M Johnson^{1

1}, Sancy A Leachman^{1

1}, Lisa G Aspinwall^{2

2}, Lee D Cranmer^{3

3}, Clara Curiel-Lewandrowski^{4

4}, Vernon K Sondak^{5

5}, Clara E Stemwedel^{6

6}, Susan M Swetter^{7

7}, John Vetto^{6

6}, Tawnya Bowles^{8

8}, Robert P Dellavalle^{9

9}, Larisa J Geskin^{10

10}, Douglas Grossman^{2

2}, Kenneth F Grossmann^{2

2}, Jason E Hawkes^{2

2}, Joanne M Jeter^{11

11}, Caroline C Kim^{12

12}, John M Kirkwood^{13

13}, Aaron R Mangold^{14

14}, Frank Meyskens^{15

15}, Michael E Ming^{16

16}, Kelly C Nelson^{17

17}, Michael Piepkorn^{3

3}, Brian P Pollack^{18

18}, June K Robinson^{19

19}, Arthur J Sober^{12

12}, Shannon Trotter^{11

11}, Suraj S Venna^{20

20}, Sanjiv Agarwala^{21

21}, Rhoda Alani^{22

22}, Bruce Averbook^{23

23}, Anna Bar^{6

6}, Mirna Becevic^{24

24}, Neil Box^{9

9}, William E Carson 3rd^{11

11}, Pamela B Cassidy^{6

6}, Suephy C Chen^{18

18}, Emily Y Chu^{16

16}, Darrel L Ellis^{25

25}, Laura K Ferris^{13

13}, David E Fisher^{26

26}, Kari Kendra^{11

11}, David H Lawson^{27

27}, Philip D Leming^{28

28}, Kim A Margolin^{29

29}, Svetomir Markovic^{30

30}, Mary C Martini^{19

19}, Debbie Miller^{6

6}, Debjani Sahni^{22

22}, William H Sharfman^{31

31}, Jennifer Stein^{32

32}, Alexander J Stratigos^{33

33}, Ahmad Tarhini^{13

13}, Matthew H Taylor^{6

6}, Oliver J Wisco^{34

34}, Michael K Wong^{35

35}

Affiliations

¹ Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA.
² University of Utah, Salt Lake City, UT, USA.
³ University of Washington, Seattle, WA, USA.
⁴ University of Arizona Cancer Center, Tucson, AZ, USA.
⁵ Moffitt Cancer Center, Tampa, FL, USA.
⁶ Oregon Health & Science University, Portland, OR, USA.
⁷ Stanford University Medical Center & VA Palo Alto Health Care System, Palo Alto, CA, USA.
⁸ Intermountain Healthcare & University of Utah, Salt Lake City, UT, USA.
⁹ University of Colorado, Aurora, CO, USA.
¹⁰ Columbia University, New York, NY, USA.
¹¹ The Ohio State University, Columbus, OH, USA.
¹² Harvard Medical School, Boston, MA, USA.
¹³ University of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ Mayo Clinic Arizona, Scottsdale, AZ, USA.
¹⁵ University of California, Irvine, Orange, CA, USA.
¹⁶ University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁸ Emory University & Atlanta VA Medical Center, Atlanta, GA, USA.
¹⁹ Northwestern University Feinberg School of Medicine, Chicago, IL USA.
²⁰ Inova Medical Group, Fairfax, VA, USA.
²¹ St Luke's University Hospital & Temple University, Bethlehem, PA, USA.
²² Boston University, Boston, MA, USA.
²³ Case Western Reserve University, Cleveland, OH, USA.
²⁴ University of Missouri, Columbia, MO, USA.
²⁵ Vanderbilt University, Nashville, TN, USA.
²⁶ Harvard Medical School & Massachusetts General Hospital, Charlestown, MA, USA.
²⁷ Winship Cancer Institute of Emory University, Atlanta, GA, USA.
²⁸ The Christ Hospital, Cincinnati, OH, USA.
²⁹ City of Hope National Cancer Center, Duarte, CA, USA.
³⁰ Mayo Clinic Rochester, MN, USA.
³¹ Johns Hopkins University, Baltimore, MD.
³² NYU Langone Medical Center, New York, NY, USA.
³³ Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece.
³⁴ Bend Memorial Clinic, Bend, OR, USA.
³⁵ University of Texas MD Anderson Cancer Center, Houston, TX, USA.

PMID: 28758010
PMCID: PMC5480135
DOI: 10.2217/mmt-2016-0022

Review

Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy

Mariah M Johnson et al. Melanoma Manag. 2017 Mar.

. 2017 Mar;4(1):13-37.

doi: 10.2217/mmt-2016-0022. Epub 2017 Mar 1.

Authors

Affiliations

¹ Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA.
² University of Utah, Salt Lake City, UT, USA.
³ University of Washington, Seattle, WA, USA.
⁴ University of Arizona Cancer Center, Tucson, AZ, USA.
⁵ Moffitt Cancer Center, Tampa, FL, USA.
⁶ Oregon Health & Science University, Portland, OR, USA.
⁷ Stanford University Medical Center & VA Palo Alto Health Care System, Palo Alto, CA, USA.
⁸ Intermountain Healthcare & University of Utah, Salt Lake City, UT, USA.
⁹ University of Colorado, Aurora, CO, USA.
¹⁰ Columbia University, New York, NY, USA.
¹¹ The Ohio State University, Columbus, OH, USA.
¹² Harvard Medical School, Boston, MA, USA.
¹³ University of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ Mayo Clinic Arizona, Scottsdale, AZ, USA.
¹⁵ University of California, Irvine, Orange, CA, USA.
¹⁶ University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁸ Emory University & Atlanta VA Medical Center, Atlanta, GA, USA.
¹⁹ Northwestern University Feinberg School of Medicine, Chicago, IL USA.
²⁰ Inova Medical Group, Fairfax, VA, USA.
²¹ St Luke's University Hospital & Temple University, Bethlehem, PA, USA.
²² Boston University, Boston, MA, USA.
²³ Case Western Reserve University, Cleveland, OH, USA.
²⁴ University of Missouri, Columbia, MO, USA.
²⁵ Vanderbilt University, Nashville, TN, USA.
²⁶ Harvard Medical School & Massachusetts General Hospital, Charlestown, MA, USA.
²⁷ Winship Cancer Institute of Emory University, Atlanta, GA, USA.
²⁸ The Christ Hospital, Cincinnati, OH, USA.
²⁹ City of Hope National Cancer Center, Duarte, CA, USA.
³⁰ Mayo Clinic Rochester, MN, USA.
³¹ Johns Hopkins University, Baltimore, MD.
³² NYU Langone Medical Center, New York, NY, USA.
³³ Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece.
³⁴ Bend Memorial Clinic, Bend, OR, USA.
³⁵ University of Texas MD Anderson Cancer Center, Houston, TX, USA.

PMID: 28758010
PMCID: PMC5480135
DOI: 10.2217/mmt-2016-0022

Abstract

Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.

Keywords: USPSTF; early detection; guidelines; keratinocyte carcinoma; melanoma; melanoma odds ratio; melanoma relative risk; melanoma risk factors; screening; skin cancer.

PubMed Disclaimer

Conflict of interest statement

Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Figures

<b>Figure 1.</b> — **Figure 1.**. **Surveillance, Epidemiology and End Results derived data, 2008–2012; comparison of the percentage of incidence and percentage mortality cases based on age.**
Data include all races and both sexes [26,27].

<b>Figure 2.</b> — **Figure 2.**. **Surveillance, Epidemiology and End Results derived data, 2008–2012; comparison of the percent of incidence and percent mortality cases based on age.**
Data include all races and both sexes [26,27]. USPSTF screening guidelines for the above cancers include: melanoma – grade I; breast cancer – grade B; colorectal cancer – grade A; cervical cancer – grade A; lung cancer – grade B. Areas shaded in gray indicate the target screening age group based on USPSTF guidelines. Area shaded in pink indicates our proposed skin cancer screening age group. USPSTF: US Preventive Sevices Task Force.

<b>Figure 3.</b> — **Figure 3.**. **Comparison of small and large basal cell carcinomas.**
Larger basal cell carcinomas (BCCs) are often associated with higher morbidity due to more complicated surgical procedures. **(A)** Patient 1 with nodular BCC prior to Mohs micrographic surgery (MMS). **(B)** Final defect after one stage MMS. **(C)** Defect repaired with complex linear layered closure. **(D)** Patient 2 with nodular BCC in a similar location to Patient 1, prior to MMS. **(E)** Final defect after three stages of MMS. **(F)** Defect repaired with a split thickness skin graft.

<b>Figure 4.</b> — **Figure 4.**. **The differences in biopsy type impact morbidity and scarring.**
**(A)** Shave biopsies are the most superficial, with the fastest healing time, but run the risk of transecting the base of the tumor. The term ‘shave biopsy’ has variable meanings depending on the practitioner and can range from a superficial incisional biopsy to a complete excisional biopsy of a thin lesion. Shaves are appropriate for biopsying thin keratinocyte carcinomas but should not be utilized for biopsying suspicious pigmented lesions. The defect heals via secondary intention. **(B)** The saucerization (i.e., deep shave or scoop) biopsy is similar to a shave biopsy but is wider and deeper (involving reticular dermis). Saucerizations may be used for biopsying suspicious pigmented lesions. The defect heals via secondary intention. **(C)** The punch biopsy allows sampling of all skin layers and may be used for biopsying suspicious pigmented lesions or keratinocyte carcinomas. The defect is closed with sutures. **(D)** The fusiform/elliptical excision is the largest type of biopsy and requires placement of sutures, leaving the largest scar.

See this image and copyright information in PMC

References

1. American Cancer Society. Cancer Facts & Figures 2016. https://cancer.org/research/cancerfactsstatistics/cancerfactsfigures2016/
2. •• Reports 2016 melanoma statistics and the American Cancer Society skin cancer screening recommendations.
1. National Cancer Institute Surveillance, Epidemiology, and End Results Program. SEER Stat Fact Sheets: Melanoma of the Skin. http://seer.cancer.gov/statfacts/html/melan.html
1. Losina E, Walensky RP, Geller A, et al. Visual screening for malignant melanoma: a cost–effectiveness analysis. Arch. Dermatol. 2007;143(1):21–28. - PMC - PubMed
1. American Academy of Dermatology. SPOTme® Skin Cancer Screenings. https://aad.org/public/spot-skin-cancer/programs/screenings
1. Curiel-Lewandrowski C, Kim CC, Swetter SM, et al. Survival is not the only valuable end point in melanoma screening. J. Invest. Dermatol. 2012;132(5):1332–1337. - PMC - PubMed

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Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy

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Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy

Authors

Affiliations

Abstract

Conflict of interest statement

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