Exámenes de detección del cáncer de piel (PDQ®)–Versión para profesionales de salud

SECCIONES

Aspectos generales

Nota: también se dispone de sumarios por separado del PDQ sobre Prevención del cáncer de piel, Tratamiento del cáncer de piel, Características genéticas del cáncer de piel (en inglés) y Grados de comprobación científica de los estudios de investigación sobre detección y prevención del cáncer.

Intervenciones

El único procedimiento de detección propuesto de forma amplia para el cáncer de piel es el examen visual de la piel, que incluye tanto el autoexamen como el examen clínico.

Beneficios

Se desconocen los efectos del examen visual en la mortalidad por cánceres de piel no melanoma en las poblaciones asintomáticas. Más aún, las pruebas son insuficientes para determinar si el examen visual de la piel en individuos asintomáticos podría conducir a una reducción en la mortalidad por cáncer de piel melanoma.

Magnitud del efecto: no corresponde (N/C).

Diseño del estudio: pruebas obtenidas a partir de un solo estudio de casos y controles.
Validez interna: precaria.
Congruencia: N/C
Validez externa: N/C

Perjuicios

Con base en pruebas razonables, pero no cuantificadas, el examen visual de la piel en individuos asintomáticos puede conducir a un aumento inevitable de consecuencias nocivas. Estas incluyen complicaciones de las intervenciones diagnósticas o de tratamiento (como una cirugía extensa), y los efectos psicológicos de ser diagnosticado con una enfermedad potencialmente mortal. Otra consecuencia perjudicial es el sobrediagnóstico que conduce a la detección de una enfermedad biológicamente benigna que, de otra forma, no se detectaría y la posibilidad de diagnosticar erróneamente una lesión benigna como maligna.

Magnitud del efecto: desconocido.

Diseño del estudio: opiniones de autoridades respetadas por su experiencia clínica, estudios descriptivos o comités de expertos.
Validez interna: razonable.
Congruencia: estudios múltiples; número reducido de participantes, sin congruencia.
Validez externa: razonable.

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Descripción de las pruebas

Skin Cancer Screening (PDQ®)—Health Professional Version - National Cancer Institute

Skin Cancer Screening (PDQ®)–Health Professional Version

SKIN CANCER

SECTIONS

Changes to This Summary (12/01/2016)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Overview

Revised text to describe the evidence of benefits of visual examination of the skin, including magnitude of effect, study design, and external validity.

Revised text to add poor cosmetic or functional outcomes as examples of complications of diagnostic or treatment interventions.

Revised text to describe the evidence of harms of visual examination of the skin, including study design and consistency.

Description of the Evidence

Added text to state that an updated review published in 2016 found limited evidence that skin cancer screening reduces melanoma mortality (cited Wernli et al. as reference 21 and Bibbins-Domingo et al. as reference 22).

Added text to state that no randomized trials evaluating the efficacy of skin cancer screening on mortality have been completed. Also revised text to state that a population-based trial to determine the effect of skin cancer screening on melanoma mortality was initiated in Queensland, Australia, and no health outcomes were ever reported (cited Aitken et al. as reference 23).

Added text to state that the highest level of direct evidence available is an ecologic study comparing melanoma mortality rates across different regions of northern Germany (the SCREEN study). Also revised text to describe the screening interventions provided in one region that conducted a population-based skin cancer awareness campaign from the SCREEN study. Also revised text to add that there was about one fewer melanoma death per 100,000 screened participants in the years after the screening program in the screened region. Also revised text to add that low participation rate and high loss to follow-up rate were important methodological limitations of the SCREEN study. Also added that an independent analysis of the SCREEN study population found that the observed modest mortality reduction did not persist with longer-term follow-up (cited Boniol et al. as reference 26).

Revised text to state that harms have not been well studied or reported in quantitative terms, but the potential for adverse consequences from skin cancer screening exists. Also added text to describe the findings from the SCREEN study, including the rate of skin excision of all screened participants. Also added that one case of melanoma was detected per 28 excisions overall (for both men and women), while 52 skin excisions were required to detect one melanoma in men aged 20 to 34 years (cited Waldmann et al. as reference 27).

This summary is written and maintained by the PDQ Screening and Prevention Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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Description of the Evidence

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