Kaiser Permanente Washington Health Research Institute, Seattle.
University of Iowa, Iowa City.
JAMA. 2018 Mar 20;319(11):1134-1142. doi: 10.1001/jama.2018.1623.
Skin cancer is the most common type of cancer in the United States. Although invasive melanoma accounts for only 2% of all skin cancer cases, it is responsible for 80% of skin cancer deaths. Basal and squamous cell carcinoma, the 2 predominant types of nonmelanoma skin cancer, represent the vast majority of skin cancer cases.
To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on behavioral counseling for the primary prevention of skin cancer and the 2009 recommendation on screening for skin cancer with skin self-examination.
The USPSTF reviewed the evidence on whether counseling patients about sun protection reduces intermediate outcomes (eg, sunburn or precursor skin lesions) or skin cancer; the link between counseling and behavior change, the link between behavior change and skin cancer incidence, and the harms of counseling or changes in sun protection behavior; and the link between counseling patients to perform skin self-examination and skin cancer outcomes, as well as the harms of skin self-examination.
The USPSTF determined that behavioral counseling interventions are of moderate benefit in increasing sun protection behaviors in children, adolescents, and young adults with fair skin types. The USPSTF found adequate evidence that behavioral counseling interventions result in a small increase in sun protection behaviors in adults older than 24 years with fair skin types. The USPSTF found inadequate evidence on the benefits and harms of counseling adults about skin self-examination to prevent skin cancer.
The USPSTF recommends counseling young adults, adolescents, children, and parents of young children about minimizing exposure to UV radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer. (B recommendation) The USPSTF recommends that clinicians selectively offer counseling to adults older than 24 years with fair skin types about minimizing their exposure to UV radiation to reduce risk of skin cancer. Existing evidence indicates that the net benefit of counseling all adults older than 24 years is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the presence of risk factors for skin cancer. (C recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of counseling adults about skin self-examination to prevent skin cancer. (I statement).
皮肤癌是美国最常见的癌症类型。尽管侵袭性黑色素瘤仅占所有皮肤癌病例的 2%，但它却导致了 80%的皮肤癌死亡。基底细胞癌和鳞状细胞癌，这两种最主要的非黑色素瘤皮肤癌，占皮肤癌病例的绝大多数。
更新 2012 年美国预防服务工作组（USPSTF）关于皮肤癌初级预防行为咨询的建议，以及 2009 年关于皮肤自我检查筛查皮肤癌的建议。
USPSTF 审查了有关咨询患者有关防晒措施是否可减少中间结果（例如晒伤或皮肤癌前病变）或皮肤癌的证据；咨询与行为改变之间的联系，行为改变与皮肤癌发病率之间的联系，以及咨询或防晒行为改变的危害；以及咨询患者进行皮肤自我检查与皮肤癌结果之间的联系，以及皮肤自我检查的危害。
USPSTF 确定，在具有浅色皮肤类型的儿童、青少年和年轻人中，行为咨询干预措施在增加防晒行为方面具有中等益处。USPSTF 发现，有足够的证据表明，行为咨询干预措施可使具有浅色皮肤类型的 24 岁以上成年人增加防晒行为。USPSTF 发现，关于咨询成年人进行皮肤自我检查以预防皮肤癌的益处和危害的证据不足。
USPSTF 建议对 6 个月至 24 岁具有浅色皮肤类型的年轻人、青少年、儿童和幼儿父母进行咨询，以尽量减少紫外线辐射的暴露，以降低皮肤癌的风险。（B 级推荐）USPSTF 建议选择性地向 24 岁以上具有浅色皮肤类型的成年人提供咨询，以尽量减少紫外线辐射的暴露，以降低皮肤癌的风险。现有证据表明，咨询所有 24 岁以上成年人的净收益很小。在确定是否在个别情况下提供此项服务是否合适时，患者和临床医生应考虑皮肤癌的风险因素。（C 级推荐）USPSTF 得出结论，目前的证据不足以评估咨询成年人进行皮肤自我检查以预防皮肤癌的利弊平衡。（I 声明）。
