• From L, Marrett L, Rosen C, Zwaal C, Johnston M, Bak K, Sibbald G, Fong J, Mai V. Screening for skin cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2007 Jun 19. 33 p. (Evidence-based series; no. 15-1). [79 references]

Recommendations

Very limited evidence was available to inform the following recommendations on screening. No prospective studies have evaluated the impact of screening on survival, quality of life, or morbidity from treatment for skin cancer nor are there data on the adverse effects of screening for skin cancer. As experts in the treatment and epidemiology of skin cancer, the guideline panel members were aware that some individuals are at increased risk for skin cancer because of personal characteristics or history. They reviewed key papers on risk and identified groups of patients who might be expected to benefit from increased surveillance for skin cancer. Separate recommendations are offered for two groups at increased risk (very high risk and high risk) and the general population.

Very high risk of skin cancer

• Individuals with any of the following risk factors have a very high risk of skin cancer (approximately 10 or more times the risk of the general population):
  • On immunosuppressive therapy after organ transplantation
  • A personal history of skin cancer
  • Two or more first-degree relatives with melanoma
  • More than 100 nevi in total or 5+ atypical nevi
  • Have received more than 250 treatments with psoralen-ultraviolet light (PUVA) for psoriasis
  • Received radiation therapy for cancer as a child

Individuals at very high risk should be identified by their primary health care provider and offered total body skin examination by a dermatologist or a trained health care provider on a yearly basis. They should also be counselled about skin self-examination and skin cancer prevention by a health care provider (e.g., physician, nurse practitioner, or public health nurse). In case of childhood cancer survivors, the site of radiation therapy should be monitored.

High risk of skin cancer

• Individuals with two or more of the main identified susceptibility factors are at a high risk for skin cancer (roughly 5 times the risk of the general population):
  • A first-degree relative with melanoma
  • Many (50-100) nevi
  • One or more atypical (dysplastic) nevi
  • Naturally red or blond hair
  • A tendency to freckle
  • Skin that burns easily and tans poorly or not at all

  Other factors that may influence the risk of skin cancers that are environmental include an outdoor occupation, a childhood spent at less than latitude 35°, the use of tanning beds during teens and twenties, and radiation therapy as an adult.

  Individuals at high risk should be identified by their primary health care provider and counselled about skin self-examination (specifically focused on the site of radiation for those having had therapeutic radiation) and skin cancer prevention by a health care provider (e.g., physician, nurse practitioner, or public health nurse). High-risk individuals should be seen once a year by a health care provider trained in screening for skin cancers.

The general population not at increased risk of skin cancer

• There is at this time no evidence for or against skin cancer screening of the general population at average risk of developing skin cancer.
• Based on the limited evidence available at present, routine total body skin examination by primary care providers is not recommended for individuals at average or low risk for skin cancer (i.e., those not included in the increased risk groups described above).
• Based on the limited evidence available at present, routine counselling on skin self-examination by primary care providers is not recommended for individuals at average or low risk for skin cancer.

None provided

The recommendations are based on evidence-based practice guidelines, one case-control study, and two comparative studies.

• From L, Marrett L, Rosen C, Zwaal C, Johnston M, Bak K, Sibbald G, Fong J, Mai V. Screening for skin cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2007 Jun 19. 33 p. (Evidence-based series; no. 15-1). [79 references]

Not applicable: The guideline was not adapted from another source.

2006 Mar 15 (revised 2007 Jun 19)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Skin Cancer Screening Guideline Panel

Members of the panel disclosed information on potential conflicts of interest. None of the principal authors of this report identified any conflicts. One panel member has acted as a consultant to pharmaceutical companies, but that was not considered to be in conflict with this screening guideline.

None available

This NGC summary was completed by ECRI on June 30, 2006. The updated information was verified by the guideline developer on July 7, 2006. This NGC summary was updated by ECRI Institute on October 2, 2007.