Skin Cancer Screening

[Andrew Joiner]

My family practice doctors always did skin cancer exams. I've been lucky in 25 years only had two spots removed. It was simple and fast. But this year he suggested a dermatologist because they have a special scope.

In searching for the latest in skin cancer screening I found this article about the pros and cons:

https://jamanetwork.com/journals/jama/fullarticle/2803802#:~:text=For%20the%20case%20of%20melanoma,o ut%20not%20to%20be%20cancer.


Now I'm wondering how necessary it is for me to get a detailed screening if I don't have any real suspicious spots on my skin.

What do you do for skin cancer screening?

[Doug Garson]

About 7 years ago I went to emergency for an unrelated issue and by luck, the ER doctor who treated me was a Dermatologist. She recognized a basal cell mole on my shoulder and recommended I make an appointment at her clinic to have it removed. I did and since then have been going once a year for a skin check-up. So far I've had three basal cell moles removed. For those who don't know, a basal cell is a slow growing type of skin cancer if left it can be serious, even fatal.

[roger wiegand]

I currently see two different dermatologists (one "regular" and one pigmented lesion cancer specialist at the Dana Farber) on an alternating schedule, seeing one every three months. I'm also participating in a whole body imaging trial for AI based detection of abnormalities. So far they've found five full-blown melanomas and another 8 or so that they graded as "extremely atypical" and another dozen or so that only made it to "atypical". I've only had 2-3 excisions that came back as normal. Fortunately all but the very first one was detected very early and treated simply.

My rule is unequivocal-- when in doubt, cut it out. I wish that I had been being screened routinely to catch the first one much earlier 20 some years ago. I'd regard a skin check by an expert to be an essential part of normal health care, like checking your blood pressure and blood glucose. You really don't want to let that first one get away on you. Your dermatologist will recommend a schedule based on your history, sun exposure, age, etc. It might be annual, but might be every 2-3 years. For those of us who work in shops and have cuts and scrapes on a very regular basis the added "risk" of what turns out to be an unnecessary biopsy or two are pretty minimal.

[Mark Rainey]

Andrew, you provide a good link. I hope everyone reads it. Cancer scares us. Fear can lead us to do good things, but also foolish things. We just do not know if routine screening for skin cancer is a good thing or a foolish thing (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/skin-cancer-screening). It is hard for us to understand this. Fortunately basal cell cancer is rarely fatal. Read the link Andrew provided. If contains wisdom. And sometimes the best wisdom says "we just don't know".

[Ken Fitzgerald]

Male pattern baldness is rapidly catching up to me. I have alternated between doing a comb-over and just cutting my hair short all over. Last spring I had it cut short all over and a few days later, I had a semiannual physical. My primary care physician noticed an odd colored mole on top of my head for the first time and referred me to a cancer clinic. There they performed a shave biopsy. Now, I will have annual checks by a skin cancer specialist. Do your research and talk with your health care providers. Make your decision based on your opinion and the opinion of the experts.

[Jim Becker]

Getting a screening by a professional that specializes in them is not a terrible thing, even if your PCP does "routine" screening as part of their normal wellness practices. It sets a baseline and that kind of screen is a lot more comprehensive in order to catch the "little signs" that might escape more cursory exams. I'm actually due for another one as it's been a few years now.

[Doug Garson]

The JAMA article overlooks one important thing, family history. According to the Skin Cancer Foundation. "Each person with a first-degree relative diagnosed with melanoma has a whopping 50 percent greater chance of developing the disease than people who do not have a family history of the disease."

https://www.skincancer.org/blog/what-you-should-know-about-your-familys-history-of-melanoma/#:~:text=Closer%20Relative%2C%20Higher%20Risk&text=Each%20person%20with%20a%20first,family%20his tory%20of%20the%20disease.

[Jack Frederick]

I do my annual trek tot the Dermatologist. He can always find something to burn/freeze off. Melanoma and Pancreatic cancer are fellow travelers and my Dad passed from PC. I see him annually and so far so good.

[Warren Lake]

got way too much sun as a kid. had a spot forehead. Asked family doctor and he said it was nothing. I said get a specialist. Specialist said its nothing. I said take it off. Turned out It was a skin cancer. he cut it off.

year later it was coming back again. I was loading a trailer of supplies to go to africa and a lady there worked for a top skin doctor. She looked and said he didnt get it all so its growing back WTF. Two doctors tell me it was nothing, not a very good reflection on their craft.

I ended up trying weed oil on it and it shrunk and has never come back.

[Sam Force]

I see a dermatologist at least once a year, have had at least a dozen pre cancer spots removed and 2 squamous cell cancer spots removed. I think a lot has to do with getting older and the sun exposure is showing up now.

[Mark Rainey]

So we have the medicalization of aging. Sad but true. Go to your doctor and have him check every inch of your body out of fear because medical science says it is not rational. Unnecessary medical procedures abound. Medical costs increase. Medical insurance skyrockets. And in the end there is no evidence that says skin screening prolongs life. The system is broken.

[Erik Loza]

I spent too much time in the sun during my 20’s and have fair skin that freckles easily. My dermatologist would slice off something pretty much every annual exam. Biopsies were always negative but then, about five years ago, I got a call saying they found something. Turned out to be a malignant melanoma. They were like, “We need to schedule your procedure ASAP”, which I took to mean it was potentially quite serious. Anyhow, I go in for mole patrol twice a year now and probably will for the rest of my life. Skin cancer just seems so easily detectable, like colon or breast.

Erik

[Stan Calow]

an exam by a skin professional is worth it. They can see spots and potential problems long before they are visible to you, especially on places like your ears, back and shoulders. Your GP may not see them or recognize them like a specialist would.

I went in with a suspicious spot that turned out to be harmless, but in the complete exam, other places were found.

[Mark Rainey]

If I look hard enough I will find cancer cells in your body. The more I biopsy the more I find. But you will not live longer. Look at Andrew's link. We just do not know.

Our data are consistent with the possibility that public health efforts directed towards early detection of melanoma may contribute to melanoma overdiagnosis, particularly with regards to in situ disease. However, it is also possible that increased biopsies are driven, in part, by underlying increases in melanoma incidence rates. Additional research is needed to further clarify the relationship between melanoma screening, incidence, and mortality. Meanwhile, the relationship between increasing biopsy rates and increasing melanoma incidence rates must be interpreted cautiously. It is notable that the incidence rate of invasive melanoma did not continue to increase between 2005 and 2009, while the rate of skin biopsies did continue to increase, suggesting that the relationship between biopsy rates and melanoma rates is not fully understood. Over-diagnosis of other cancers such as breast, prostate and thyroid cancers has been reported, with efforts underway to reduce unnecessary cancer-related screening, surveillance, and other medical interventions (3 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357200/#R3)). Similarly, we believe that continued collaborative efforts are needed to further advance the dermatologic community toward optimized care delivery for all patients at risk for melanoma.

[roger wiegand]

I'm surprised that the data for early removal of potentially deadly tumors isn't more compelling. Surprised to the point where that little bell in the back of my head that saw me through a long and fairly successful career as an experimental biologist is ringing loudly, suggesting that there is something wrong with the data/experiment. Unfortunately the cost and size of the clinical trial required to properly answer the question means it's not going to happen.

I guess the argument is that for many people they will die of something else before the melanoma kills them, and therefore shouldn't bother looking for it. I don't, personally, find that argument particularly comforting. There is an argument to be made for "watchful waiting", which is how most prostate cancer is managed in the US. In most people that cancer is very slow moving and, indeed, most people outlive it. But I'd put the emphasis on "watchful"-- know it's there and pay attention to how fast it's growing to make individual treatment decisions. Intervention for prostate cancer can carry a pretty high cost in terms of effect on the patient, so such an approach is well justified.

In the case of melanoma one might make the same argument, but the cost of intervention is very low-- basically doing the diagnostic test, a shave biopsy, effectively treats the cancer when done early enough. Allowing tumors to progress to the point where much more invasive interventions like lymph node removals, chemo, and radiation are needed for treatment, even if just in a few percent of patients, seems really hard to justify.

It may well be the case that from an economic point of view we'd do better if the standard treatment were to simply excise suspicious spots without doing any pathology exam unless they recur, as that early excision is successful in a large majority of cases. But not looking at all? I'm not buying it without much more compelling data.

[Mark Rainey]

Good to have a fellow scientist comment Roger. We cannot say screening skin for cancer saves lives. Cancer is a very complex biologic phenomenon. It as not as simple as "cutting it out". We have cancer cells in our body and usually our body destroys them. Early detection usually doesn't work. Shocking for some, but once again, cancer is complex.














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Original Investigation

August 28, 2023
Estimated Lifetime Gained With Cancer Screening TestsA Meta-Analysis of Randomized Clinical Trials


Michael Bretthauer, MD, PhD1 (https://jamanetwork.com/searchresults?author=Michael+Bretthauer&q=Michael+Bretthauer); Paulina Wieszczy, MSc, PhD1,2 (https://jamanetwork.com/searchresults?author=Paulina+Wieszczy&q=Paulina+Wieszczy); Magnus Løberg, MD, PhD1 (https://jamanetwork.com/searchresults?author=Magnus+L%c3%b8berg&q=Magnus+L%c3%b8berg); et alMichal F. Kaminski, MD, PhD1,2,3 (https://jamanetwork.com/searchresults?author=Michal+F.+Kaminski&q=Michal+F.+Kaminski); Tarjei Fiskergård Werner, MSc4 (https://jamanetwork.com/searchresults?author=Tarjei+Fiskerg%c3%a5rd+Werner&q=Tarjei+Fiskerg%c3%a5rd+Werner); Lise M. Helsingen, MD, PhD1 (https://jamanetwork.com/searchresults?author=Lise+M.+Helsingen&q=Lise+M.+Helsingen); Yuichi Mori, MD, PhD1,5 (https://jamanetwork.com/searchresults?author=Yuichi+Mori&q=Yuichi+Mori); Øyvind Holme, MD, PhD1 (https://jamanetwork.com/searchresults?author=%c3%98yvind+Holme&q=%c3%98yvind+Holme); Hans-Olov Adami, MD, PhD1,6,7 (https://jamanetwork.com/searchresults?author=Hans-Olov+Adami&q=Hans-Olov+Adami); Mette Kalager, MD, PhD1 (https://jamanetwork.com/searchresults?author=Mette+Kalager&q=Mette+Kalager)
Author Affiliations
JAMA Intern Med. 2023;183(11):1196-1203. doi:10.1001/jamainternmed.2023.3798



Full Text
Key PointsQuestion Cancer screening tests are promoted to save lives, but how much is life extended due to commonly used cancer screening tests?
Findings In this systematic review and meta-analysis of 18 long-term randomized clinical trials involving 2.1 million individuals, colorectal cancer screening with sigmoidoscopy prolonged lifetime by 110 days, while fecal testing and mammography screening did not prolong life. An extension of 37 days was noted for prostate cancer screening with prostate-specific antigen testing and 107 days with lung cancer screening using computed tomography, but estimates are uncertain.
Meaning The findings of this meta-analysis suggest that colorectal cancer screening with sigmoidoscopy may extend life by approximately 3 months; lifetime gain for other screening tests appears to be unlikely or uncertain.

Think twice before going to the doctor for "your health". Don't medicalize your golden years with endless trips to the doctor with biopsies, colonoscopies, stress tests, orthopedic procedures, and ablative surgeries. Take a walk, talk to a friend or loved one. Make something in the shop.

[Ole Anderson]

As we age, we add to the stable of physicians attending to us for various conditions. Skin is our largest organ, why not attend to it accordingly? I do. While only one or two were "pre-cancerous", in the last two years I had about two dozen SKs (seborrheic keratoses) removed, largely for aesthetic issues. Liquid nitrogen squirted on the spot and within two weeks they fall off. A close friend was just diagnosed with stage four melanoma, a common side effect of his multiple myeloma. He ignored obvious signs until surgery with wide margins was the only option. Sad.

[Stan Calow]

It's not just about extending your life. I've seen friends with cancers on their heads and faces, and it's not pretty.

You can get melanoma in your eye too. Not good.

[Mark Rainey]

As we age, we add to the stable of physicians attending to us for various conditions.
True, but do we need a stable of physicians to maintain our health after age 65? Probably not. I get paid for these services, but I do not think most are necessary.

[Jim Becker]

For those of us more comfortable with using specialists for certain aspects of our wellness care, so be it. For those who prefer otherwise, so be it. Healthcare needs and decisions are individual choices.

[Cameron Wood]

A high school friend died from melanoma in his 30s. We both spent a lot of time at altitude in the mountains. I had a melanoma spot removed on my back that was pretty advanced, since I couldn't see it. It was a major surgery- now I get checked twice a year.

[Brent Gamble]

Melanoma killed my father. I have a 41-year-old niece (sister's daughter) battling stage 4 metastatic melanoma. My son and I have had numerous atypical spots biopsied and removed. A couple of times we each have had wide area excisions due to the severity of the atypia. Everybody in my family gets checked on a regular basis.

[Bill George]

Melanoma killed my father. I have a 41-year-old niece (sister's daughter) battling stage 4 metastatic melanoma. My son and I have had numerous atypical spots biopsied and removed. A couple of times we each have had wide area excisions due to the severity of the atypia. Everybody in my family gets checked on a regular basis.

Correct we have two friends die from skin Cancer, anyone who tells you to Ignore it will go away is a fool. If you wait to long the results are terrible to see. Nope I will go in every six months and have a little little N2 or some slice and dice work done. People are living longer and the old advice to just let it go is no longer valid. The person or people giving that advice is wrong.

[Ted Calver]

As a child of the fifties, when sunscreen consisted of baby oil with iodine, I managed to get some frightful sun burns. Out of an abundance of caution there have been yearly dermatologist visits for many years. Last year they discovered a melanoma in situ, meaning it had not spread, and removed a sizeable chunk of skin from my back. Now I visit every six months and always get a chuckle, because it's the only time outside of marriage I get to strip in front of a beautiful young lady and she doesn't run away. Maybe I should go every three months??

[Mike Henderson]

A friend of mine died from melanoma. It was not pretty.

Mike

[Warren Lake]

family doctor and specialist both said it was nothing and sent me away but i didnt accept that. Poor service to say the least.

Top cabinetmaker I knew lost his son at 32 to Melanoma,no history in the family. Kid was not out in the sun much and he didnt drink much. Bit of beer but it was good european stuff. Father smart and strong and could fix anything, hurt him he was not able to save his own son. Other son scizophrenic. No easy thing both for parents, just the mom left now.

[Bill George]

What I don’t get mine is all covered by Insurance, its not expensive to correct early before it leads to death or worse. Why take a chance? I have a big ugly scar on the side of my face from one surgery that one Dr. Clown said nothing to worry about!

Find a good dermatologist and go once a year or whatever they recommend.