We read with great interest your editorial concerning the US Preventive Services Taskforce (USPSTF) skin cancer screening guidelines in the July/August 2018 issue of Missouri Medicine1. You emphasized the importance of visual skin cancer screening as a life-saving approach in the context of the controversial USPSTF recommendations.
We share your concerns regarding the USPSTF conclusion that current evidence on benefits of early detection and treatment of skin cancer is inadequate2. Melanoma five-year survival depends on the stage of the disease: over 98% for stage I, and only 18% for stage IV disease.4, 5 This strongly suggests that in early stages, melanoma is a highly treatable condition. Most melanoma deaths might be prevented by total body skin cancer examination to identify early-stage melanomas, before they develop into an advanced life-threatening stage.5 Skin is one of the only organs that can be safely inspected without any invasive procedures: visual skin cancer screenings are not only safe and easy, but among the most cost-effective medical tests.5
We agree that visual skin screening by a “clinician” for the “general population” may lead to misdiagnosis and overdiagnosis, among other possible harms.2 We should therefore apply the data-driven screening guidelines that suggest benefit from targeting high-risk populations (based on age, personal and family history, physical features, and UV exposure), highly vulnerable to a delay in melanoma skin screening and diagnosis.5 In addition, a “clinician” with less specialty dermatologic training may likely contribute to the mis- and overdiagnosing phenomenon; however, a specialty trained clinician is in a perfect position to detect and diagnose skin malignancies by routine visual examination.5, 6
There are well-documented reasons why randomized controlled trials of visual skin cancer screening in high-risk patients may not be possible. We respect and appreciate the invaluable work done by the USPSTF regarding disease prevention and preventive services. However, we strongly encourage the USPSTF to take into consideration input from experts in the field before making final recommendations.
References
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