Conflicts and Contradictions in Current Skin Cancer Screening Guidelines

The purpose of this paper is to review skin cancer screening guidelines from major public health/medical organizations. No consensus exists on whether or not screening to prevent skin cancer is warranted. The best evidence of screening efficacy should come from population-based randomized trials, but is unlikely to exist due to feasibility constraints. Consequently, consensus should be built from observational/non-randomized designs, such as the SCREEN study in Germany. Current guidelines often focus on melanoma alone, while potential benefits of screening for non-melanoma skin cancers (NMSC) are largely overlooked. There may be less room for doubt regarding the value of screening, if both diseases were considered. Further, targeted approaches, i.e., screening only in high-risk populations, remain poorly defined and untested. Continuing to state that there is insufficient evidence to recommend screening leads to confusion about whether or not to screen and is unlikely to result in substantial changes to the morbidity of NMSC and significant mortality from melanoma.