Curbside Consults

VOL 116 / NO 5 / NOVEMBER 2004 / POSTGRADUATE MEDICINE

Skin cancer screening guidelines for older patients?

Q: What are the skin cancer screening guidelines for older patients who sustained severe sunburns as children?

Primary care physician, Mississippi

A: Severe sunburns sustained early in life increase the likelihood of skin cancer, particularly malignant melanoma and basal cell carcinoma, throughout adulthood. Actinic keratoses and squamous cell carcinomas develop principally as a result of ongoing sun exposure. In our culture, in which early detection equates with good clinical practice and lawsuits for delayed diagnosis abound, it seems intuitive that screening for skin cancer under these circumstances ought to be the standard of care.

Regrettably, the incidence of melanoma continues to increase at an alarming rate. This year, more than 7,700 persons will die of this tumor. More than 1 million basal cell carcinomas, with their attendant scarring, cost, and inconvenience, will be diagnosed. Ideally, early detection of cancer leads to a reduction in both morbidity and mortality without unduly increasing the burden of anxiety, unnecessary biopsies, and additional expense. At the same time, screening must not provide a false sense of security.

Unfortunately, there is no consensus among medical associations in regard to screening. The American Academy of Dermatology and the American Cancer Society support screening every 1 to 3 years. However, the US Preventive Services Task Force has concluded that currently available evidence does not allow it to take a stand on the issue. The task force specifically addresses screening in high-risk persons and notes that claims of benefit appear unproven.

The Canadian Task Force on Preventive Health Care guidelines for the general population basically echo those of the US panel. In Australia, where the incidence of melanoma surpasses that of any other nation, guidelines do not support screening except if there is a personal or close family history of melanoma.

Ken Landow, MD
Clinical Professor of Dermatology
University of Southern California School of Medicine
Los Angeles

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