Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.
These recommendations were finalized by the Task Force in March 1994
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Total body skin examination. | For normal risk individuals has not been proven as an effective early detection maneuver. | Comparison of times and places <7-9> (II-3) | There is poor evidence to include or exclude from the periodic health examination (PHE) of the general population (C); there is fair evidence for the inclusion of total body skin examination for a very select sub-group of individuals. (B) |
| For individuals at significantly increased risk (i.e. family melanoma syndrome (MM) first degree relative with melanoma) it is prudent to undertake regular examinations (dermatologists may be more accurate assessors). | Comparison of times and places <10-12> (II-3) | ||
| Self-Exam | There has been no evaluation of patient ability to detect lesions or of physician ability to alter patient screening skills or behaviour except for one study with a positive predictive value of 7% for MM. | Comparison of times and places <4> (II-3) | There is poor evidence to include or exclude in the periodic health examination. (C) |
| Avoidance of sun exposure and protective clothing. | Evidence from epidemiologic studies focusing on etiology of melanoma, prudence and low cost/side-effects supports the avoidance of excessive sun exposure at mid-day, plus the use of protective clothing. | Epidemiologic and case-control studies <2-6> (II-2) | On the basis of epidemiologic data and case-control studies, and prudence, there is fair evidence to include in the periodic health examination. (B) |
| Sunscreens (for prevention of squamous cell and basal cell carcinoma; and malignant melanoma. | Studies have indicated no effect or raised concerns of increased risk among sunscreen users. At present, the evidence is inconclusive. | Cohort and case-control studies <17-19> (II-2) | There is poor evidence for the inclusion or exclusion of advice on sunscreen use in the PHE to prevent squamous cell carcinoma, basal cell carcinoma and malignant melanoma. (C)* |
* A randomized controlled trial<16> has demonstrated that sunscreens can reduce the rate of recurrence or development of new solar keratoses. While solar keratoses are precursor lesions for squamous cell carcinoma (SCC), they do not represent a sufficiently strong intermediate outcome measure to provide evidence of effectiveness in preventing SCC. There is fair evidence for recommending the use of sunscreens for the reduction of solar keratoses only. (B Recommendation for persons with a prior history of solar keratosis who cannot avoid sun exposure).
Link to Full Text of this review
Link to Structured Abstract of this review
Link to Selected References list of this review
Reprinted in modified format by the Canadian
Task Force on Preventive Health Care
with permission.
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© 1994 Minister of Supply and Services Canada.
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Last modified March 27, 1998.
