Skin Cancer Screening Recommendations

Skin Cancer Screening Recommendations

The annual skin cancer screening by full body skin examination by health care provider is an I recommendation by USPSTF. I recommendation means that current evidence is insufficient to assess the balance of benefits and harms of a primary care clinician performing a whole body skin examination or a patient doing a skin self-examination for the early detection of skin cancers.

However, the American Cancer Society recommends appropriate cancer screening by a physician, including a skin examination, during a periodic health examination. The American Academy of Dermatology promotes free skin examinations by volunteer dermatologists for the general population through the Academy’s Melanoma/Skin Cancer Screening Program. It also encourages regular self-examinations by individuals.

In the context of apparently conflicting recommendations by different organizations and when there is no sufficient evidence for the benefit or harm of certain recommendations, (like USPSTF I recommendation), the best policy may be to discuss the recommendation with patients and ask their preference. Physicians, however, should be able to discuss the possible outcomes of

the patient’s choice.

Risk For Skin Cancer

Risk factors for nonmelanoma skin cancers include:

1.  Previous skin cancer of any type gives 36% to 52% five-year risk of second skin cancer

2.  80% of lifetime sun exposure is obtained before 18 years of age (single greatest risk factor) 3. Celtic ancestry

4.  Fair complexions

5.  People who burn easily

6.  People who tan poorly and freckle

7.  Red, blonde or light brown hair

8.  Increasing age

9.  Use of coal-tar products

10.  Tobacco use

11.  Psoralen use (PUVA therapy)

12.  Male >>> female

13.  Living near equator (UV exposure)

14.  Outdoor work

15.  Chronic osteomyelitis sinus tracts

16.  Burn scars

17.  Chronic skin ulcers

18.  Xeroderma pigmentosum

19.  Human papillomavirus infection

Risk factors for melanoma skin cancer include:

1.  Previous melanoma

2.  Celtic ancestry

3.  Fair complexions

4.  People who burn easily

5.  People who tan poorly and freckle

6.  Red, blonde or light brown hair

7.  Early adulthood and later in life

8.  “Intense, intermittent exposure and blistering sunburns in childhood and adolescence are associated with increased risk”

9.  Radiation exposure

10.  Melanoma in 1st or 2nd degree relative

11.  Familial atypical mole-melanoma syndrome (FAMMS)

12.  Male > female (slight)

13.  Living near equator (UV exposure)

14.  Indoor work

15.  Higher incidence in those with more education and/or income

16.  Nonfamilial dysplastic nevi

17.  Large number of benign pigmented nevi

18.  Giant pigmented congenital nevi

19.  Nondysplastic nevi (markers for risk, not precursor lesions)

20.  Xeroderma pigmentosum

21.  Immunosuppression

22.  Previous nonmelanoma skin cancer

23.  Other malignancies

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