Beverly McCormick gets a full-body exam for skin cancer every six months. With blond hair, freckles and light skin, she’s not taking any chances.
Ms. McCormick, a 64-year-old manager in the financial-services department at the Christ Hospital in Cincinnati, says that over the years her dermatologist has removed a squamous cell carcinoma—a type of skin cancer—as well as numerous precancerous lesions.
“This isn’t one of those preventive services like mammograms or pap smears that are always covered by insurance,” she said. Most of the cost goes toward her high-deductible insurance plan.
Melanoma accounts for the majority of skin cancer-related deaths and is the fifth most common invasive cancer in men and the seventh in women. There is no national consensus on who should be screened for melanoma or how often, so insurance coverage varies.
Currently, most patients who get regular exams, like Ms. McCormick, consult a dermatologist on their own initiative. But some experts say screening for melanoma should be more widespread and accessible. In a perspective piece published last week in the journal Melanoma Management, more than 50 dermatologists and skin-cancer experts called for uniform guidelines to help individuals determine whether they should get regular total-body skin exams.
Such tests usually entail a 10-to-20-minute head-to-toe examination in which a health professional studies the size, shape, color and borders of moles, including in hard-to-spot places such as the scalp, under fingernails, behind the ears and even in the iris of the eyes. Any suspicious-looking moles often will be tested for skin cancer.
The Melanoma Management article was written in response to a 2016 recommendation from an influential national task force concluding that there was insufficient evidence to recommend that primary care physicians perform visual skin cancer screenings in adults without any symptoms for melanoma.
The U.S. Preventive Services Task Force recommendations are generally followed by insurers and federal health-care programs such as Medicare when deciding what procedures to cover. A USPSTF spokeswoman said the task force doesn’t generally comment on individual studies.
In the Melanoma Management article, the experts recommend an annual total body skin exam for people between the ages of 35 and 75 with one or more risk factors. Such factors include previous cases of melanoma, a mutation in a melanoma gene or a compromised immune system. Other risk factors: a family history of melanoma or a history of indoor tanning and blistering sunburns. Finally, an annual exam is recommended for individuals with a broad array of physical features, such as light skin; blond or red hair; lots of freckles; severely sun-damaged skin; 40 or more moles; or two or more atypical moles.
“It’s probably one of the most cost-effective screenings you can think about.” said Sancy Leachman, director of the melanoma research program at Oregon Health & Science University’s Knight Cancer Institute in Portland.
Dr. Leachman was one of the two first authors on the perspective piece. Because there isn’t a high concentration of dermatologists in every part of the country, she said, it makes sense for primary-care physicians also to perform exams. But to do so, insurance coverage is necessary, she said.
Some experts say the criteria set forth in the Melanoma Management article don’t go far enough.
“I recommend that every adult have an annual skin examination,” said Elizabeth Hale, a clinical associate professor of dermatology at New York University Langone Medical Center and senior vice president of the Skin Cancer Foundation, which also recommends annual screenings for everyone.
Dr. Hale recommends that individuals with risk factors such as indoor tanning, light skin, freckles or atypical moles get two scans a year. “What makes skin cancer so unique is early detection is possible and so critical,” she said. The average five-year survival rate is as high as 98% for melanoma caught at an early stage, but drops to about 18% once it is stage four, or has spread to other organs.
Darrell Rigel, a clinical professor of dermatology at New York University Medical School, noted that the USPSTF didn’t say screenings were bad, but rather that there weren’t enough data to make a recommendation one way or the other. “If you detect the melanoma earlier, of course it’s better, but the question is how much better?” he said.
More screenings may mean more biopsies, which could include unnecessary ones, he said. But there are also many biopsies from earlier screenings that find more skin cancers.
For people without signs of symptoms of melanoma and without a family history, Dr. Rigel recommends doing self-exams, or following the ABCDE’s. The acronym stands for asymmetry; irregular borders; uneven color; a diameter greater than a half-inch; and moles that evolve or change.
“Learn your own skin, learn your moles,” he said. “It takes a while to learn what to look for.”