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Gov鈥檛 Task Force Finds Evidence Lacking to Support Visual Skin Cancer Screenings

A medical consultation at the Removal of nevus.

For years, many dermatologists have urged patients to have a full-body visual check for skin cancer. But a new聽聽by a panel of medical experts concluded for the second time in seven years that there is not enough evidence that these screenings benefit patients to recommend them as a preventive service.

In a review published Tuesday in JAMA, the U.S. Preventive Services Task Force updated its 2009 review of visual skin cancer exams, but still issued an 鈥淚鈥 rating, which means 鈥渢he current evidence is insufficient to assess the balance of benefits and harms.鈥

Dr. Michael Pignone, a task force member and chair at the Dell Medical School at the University of Texas at Austin, emphasized that this finding does not mean screenings have no benefit and no harm. 鈥淚t鈥檚 a statement that the evidence isn鈥檛 good enough,鈥 he said.

The task force, an independent volunteer panel of medical experts, reviews current scientific evidence for specific preventive services and makes recommendations about that services鈥 effectiveness for patients who don鈥檛 have obvious symptoms or aren鈥檛 at high risk.

Their findings are important because, under the health law, services that the task force assigns must generally be covered by health plans, including Medicare, without charging consumers anything out of pocket.

The panel conducted a of 13 studies to analyze the screening鈥檚 ability to reduce deaths caused by melanoma, possible harms that result from biopsies and whether the exam leads to earlier detection of skin cancer.

Its rating comes even as skin cancer rates continue to climb. According to the latest data from the Centers for Disease Control and Prevention, skin cancer is the in the U.S. More than 9,000 U.S. adults died in 2013 from melanoma, a rare but highly aggressive form of skin cancer. In the same year, nearly 74,000 were diagnosed with some form of the disease.

Just as the 2009 鈥淚鈥 determination triggered dissent within the medical profession, Tuesday’s updated rating was accompanied by editorials ranging from support to concern and even criticism.

In one opinion published in , a trio of physicians decried the rating, claiming the recommendation 鈥渄ownplays鈥 the importance of the visual screening procedure. The USPSTF鈥檚 methods of analysis were 鈥渢oo restrictive,鈥 the doctors wrote, pushing instead for a higher rating to 鈥渆mphasize screening as a part of regular physical examinations.鈥 They also suggested that the visual exam could be targeted to patients based on age and sex. The also noted that, while questions persist about screening, 鈥淐urrent mortality from melanoma cannot be ignored.鈥

Editorials published in and took a different view, highlighting the report鈥檚 findings as an 鈥渋nvitation鈥 for more research on the harms and benefits of visual skin cancer screening. They also emphasized the need to better educate doctors about skin cancer and standardize how screenings are administered.

鈥淏eing able to pick up a melanoma early, just from looking at it, is a lifesaving procedure on its own,鈥 said Dr. Hensin Tsao, director of the Melanoma Center and Pigmented Lesion Center at Massachusetts Hospital and co-author of the JAMA editorial.

But, he concluded, its value is hard to prove.

Pignone and Tsao don鈥檛 foresee doctors substantially changing their services in response to the rating, but Tsao said it could recast screenings from being considered 鈥減art of a general check-up鈥 to a 鈥渄iagnostic exam.鈥 That means the service must meet a higher threshold to prove its effectiveness.

For now, Pignone said the lack of scientific information places the onus on individuals to choose the best course of action for their health, and on the scientific community to come up with evidence to identify the best strategies.

鈥淚t鈥檚 challenging to get good evidence and this is a case where we have to meet that challenge,鈥 Pignone said.

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