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UPDATING THE RULES FOR SKIN CANCER CHECKS

The U.S. Preventive Services Task Force says that annual screenings for people without a history are unnecessary.

New York Times

Now is a good time to note how much sun damage you incurred this summer - and how good a job you're doing shielding your skin. But unless you've already had one of the common skin cancers or a melanoma, the U.S. Preventive Services Task Force does not recommend a yearly head-to-toe checkup for skin cancer.

In updated guidelines, the task force found insufficient evidence to justify periodic "screening for skin cancer by primary care clinicians or by patient self-examination."

The task force found no direct evidence that whole-body skin exams "improves patient outcomes" and that studies were lacking to determine the extent of harm that could come from such screening. The possible risks it listed were "misdiagnosis, overdiagnosis and the resultant harms from biopsies and overtreatment."

In other words, there is not enough information to say whether the benefits of routine skin cancer screening outweigh the potential risks associated with examining and treating lesions that turn out not to be cancer.

This is not to say that if you notice something suspicious anywhere on your skin you should ignore it.

Dr. Darius R. Mehregan, chairman of dermatology at Wayne State University School of Medicine in Michigan, agrees that for most adults an annual skin cancer checkup by a physician is not needed. Still, in an interview, Mehregan suggested that patients should do a monthly self-check for the "A, B, C, D and E" of skin cancer starting around age 50. This means looking for lesions with any of these characteristics: A for asymmetry, B for irregular border, C for multiple colors, D for a diameter greater than 6 millimeters and E for evolving (that is, growing or changing).

Dr. Gary N. Fox, who practices dermatology in Defiance, Ohio, a farming area where skin cancers are rampant, also sees little to be gained from routinely screening people who do not have risk factors for skin cancer. But in an interview, Fox emphasized the importance of insisting on a biopsy if someone had a lesion that "causes sufficient patient or doctor concern, even if it has been there for 20 years."

Of course, if you have already had one skin cancer - a basal cell or squamous cell carcinoma or, more serious, a melanoma - you should be regularly examined as well. Fox said a person who has had one basal cell cancer has a 50 percent chance of developing a new one within three to five years.

Because melanomas run in families, Fox added, anyone with a family history of the disease should start regular skin exams in their 20s. Likewise, Mehregan said, people who have many moles should get an early start on screening because it is difficult for patients to determine when a melanoma arises in a mole.

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