Journal of Clinical and Aesthetic Dermatology

APR 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

Issue link: https://jcadonline.epubxp.com/i/959274

Contents of this Issue

Navigation

Page 51 of 61

52 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY February 2018 • Volume 11 • Number 2 C O M M E N T A R Y T In 2016, the United States Preventive Services Task Force (USPSTF) updated its 2009 recommendation for skin cancer screening in asymptomatic healthy adults. 1 The task force again concluded that "current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults." Recently published editorials present rational counterarguments to the USPSTF's conclusions. 2–5 One contributing factor leading to the "insufficient grade" was a concern for cosmetic harms resulting from unnecessary biopsies or excisions (removal of clinically suspicious pigmented lesions subsequently determined to be benign by pathologic exam). In this commentary, we seek to clarify data regarding the potential cosmetic harms of skin cancer screening since this has not been specifically addressed in prior commentaries. The USPSTF cites two "fair-quality" studies that attempt to extrapolate measures of harm from screening via patient satisfaction and biopsy yield. 6,7 The first study investigated cosmetic results of deep shave excision of clinically benign nevi, and revealed that seven percent (4/56) of patients and 16 percent (9/56) of physicians expressed poor satisfaction. 7 The USPSTF acknowledges that these findings "do not directly assess cosmetic results from excisional biopsies needed for melanoma diagnosis." The second cited article notes that 22 to 41 "excisions" might be necessary to detect one melanoma. 6 Two critical flaws in the USPSTF's analysis of these studies should be addressed. First, the USPSTF underscores the untoward cosmetic events identified by Gambichler et al 7 despite the investigators' emphasis of favorable patient-reported cosmetic results of shave removal of skin lesions (89% of 56 patients graded their scar as excellent or good six months after biopsy, regardless of anatomic location). The USPSTF position is further weakened because nevi were removed for cosmetic purposes, not for suspicion of malignancy. Cosmetic patients might be more discriminating about postoperative results, 8 and satisfaction scores might be higher in a cohort of patients with clinically suspicious nevi. In a comparable study not reported by the USPSTF, Ferrandiz and colleagues 9 evaluated the cosmetic results of mid-dermal shave biopsies of 204 benign nevi. Similarly, 92 percent of patients graded their scars as excellent or acceptable. Perhaps most telling, 98 percent of patients stated they preferred their new scar compared to the pre- existing mole and that they would be willing A B S T R A C T The United States Preventive Services Task Force (USPSTF) 2016 recommendation for skin cancer screening in asymptomatic healthy adults concluded that current evidence is "insufficient to assess the balance and harms of visual skin examination." One contributing factor leading to the insufficient grade was a concern for cosmetic harms resulting from unnecessary biopsies or excisions. This commentary briefly highlights the pertinent studies and currently accepted methods for pigmented lesion biopsy. Reviewing these data will permit clinicians to more thoroughly analyze the USPSTF statement and might assist in routine assessment and management of suspicious pigmented lesions in adult patients. KEYWORDS: skin cancer, melanoma, skin cancer screening, U.S. Preventive Task Force, skin biopsy United States Preventive Services Task Force Overstates Cosmetic Harms of Skin Cancer Screening by JOSEPH F. SOBANKO, MD; KIMBERLY SHAO, BS; REBECCA L. PEARL, PhD; and SANC Y LEACHMAN, MD PhD Dr. Sobanko is with the Division of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology, at the University of Pennsylvania Health System in Philadelphia, Pennsylvania. Ms. Shao is with the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania. Dr. Pearl is with the Department of Psychiatry and Department of Surgery, Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania. Dr. Leachman is with the Department of Dermatology at Oregon Health & Science University in Portland, Oregon. J Clin Aesthet Dermatol. 2018;11(4):52–53 FUNDING: No funding was provided for this article. DISCLOSURES: Dr. Leachman is a consultant for Myriad Genetics and Castle Biosciences. CORRESPONDENCE: Joseph F. Sobanko, MD; Email: joseph.sobanko@uphs.upenn.edu

Articles in this issue

Links on this page

Archives of this issue

view archives of Journal of Clinical and Aesthetic Dermatology - APR 2018