The skin cancer screening paradigm: Reviewing current guidelines for detecting melanoma in the US

The Future Science Group (FSG) journal Melanoma Management, today announces the publication of a new perspective article, in which over 50 leaders in the dermatology field critically assess current screening practice for melanoma in the US.

Presently, the safest and most cost-effective method of screening for melanoma, a deadly form of skin cancer, is through total body skin examination. However, there being no current national consensus on how to implement the procedure or its benefit.

In the perspective piece, led by Sancy Leachman and Mariah Johnson from the OHSU Knight Cancer Institute's Melanoma Research Program at the OHSU School of Medicine (OR, USA), more than 50 leading members of the skin cancer field brought their expertise together to review current screening practice in primary care, as recommended by the US Preventive Service Task Force's (USPSTF) 2016 Draft Recommendation Statement in light of the most recent melanoma epidemiology.

In doing so, the group proposed a series of data-driven guidelines that highlighted risk groups for melanoma and provided full screening recommendations for those individuals. To further develop their guidelines, the group also reviewed international screening guidelines from Australia, New Zealand, Germany and elsewhere, modelling their recommendations appropriately.

A key aspect of the perspective article was the group's critique of the USPSTF statement and the rationale that lead to it. The experts raised a series of questions to assess the guidelines and promote active discourse, including asking why morbidity associated with delayed diagnosis of melanoma was omitted from the USPSTF's risk estimates; whether it was valid to extrapolate the satisfaction results from cosmetic procedures to results from a diagnostic procedure for a cancer; and challenging the methodology behind the sourcing of publications that formed the reasoning behind the statement.

"In many ways, it's surprising that our field is currently without a national consensus for skin cancer screening guidelines for patients without symptoms," stated Leachman. "One of the goals of this paper was to propose data-driven, evidence-based guidelines for screenings that are consistent with the USPSTF guidelines for other cancers and diseases. The guidelines are of course just a starting point based on patient data we've reviewed to date, but we've identified a strong need to provide providers with initial recommendations outlining when to recommend screenings to their patients."

"Given the current rates of melanoma diagnoses in the US, it is fascinating to see how the field continues to address screening inadequacies for a cancer with potentially such high mortality rates," commented commissioning editor for Melanoma Management, Sebastian Dennis-Beron. "It has been a pleasure to work with Dr Leachman and her colleagues to develop this timely and thought provoking piece, as to really underline the need to develop evidence-based screening guidelines for melanoma patients, given how vital early detection is for survival".