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Visual skin cancer checks get shrug from task force

Doctors press for screenings

A federal task force that assesses the value of medical screening tests says it can’t judge whether skin cancer checks by dermatologists are worth the trouble for healthy Americans because good research on the practice is lacking.

The finding of the U.S. Preventive Services Task Force is not a repudiation of the practice recommended by the American Academy of Dermatology, in which a medical professional inspects a patient’s skin for moles, thickening, discoloration or tags that might be cancerous.

But the task force does say there are not enough well-conducted studies to establish the practice saves lives without incurring undue risks for patients. And it could influence health insurers not to cover skin cancer screenings for people who have no history of the disease.

Each year, 5.4 million new cases of basal and squamous cell carcinomas are diagnosed, and while they are seldom fatal, they can cause disfiguration and metastasize to other parts of the body if left untreated. The most deadly form of skin cancer, malignant melanoma, is diagnosed in more than 76,000 new patients yearly, and claims the lives of 10,000 Americans a year. Its incidence is growing faster than that of any other preventable cancer.

So the task force’s “ehh” finding prompted a chorus of concern.

In a statement released Tuesday, the American Academy of Dermatologists said it was disappointed by the finding.

“Dermatologists know that skin cancer screenings can save lives,” the academy said. Since the Academy launched a skin cancer screening initiative called “SPOTme” 30 years ago, the Academy said, dermatologists have performed more than 2.5 million screenings during which they have found more than 255,000 suspected nonmalignant skin cancers and 28,500 melanomas.

“We know that screenings, which are noninvasive, quick and painless, are the best tool possible to detect skin cancer early when it is most treatable,” the academy said.

At the same time, the dermatologists’ professional society wrote, “we acknowledge the need for additional research on the benefits and harms of skin cancer screening in the primary care setting.”

Writing in JAMA Oncology on the Preventive Services Task Force’s recommendation, a trio of dermatologists pressed the case for continued screening.

Most patients — even those who have already been treated for melanoma, according to research — don’t check their skin thoroughly for problematic growths, wrote a team of dermatologists led by University of Mississippi dermatologist Vinayak K. Nahar. They overlook places where skin cancers can hide, or don’t use a mirror to get a closer look, or don’t enlist a loved one to help.

And let’s face it: Patients don’t really know what to look for, suggested dermatologists Hensin Tsao and Martin A. Weinstock, who wrote a JAMA editorial on the task force’s finding.

The American Cancer Society recommends that primary care physicians check for skin cancer in all patients 20 or older during regular checkups.

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