…included in the Free/No Cost Preventive Services available in all health insurance.

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Why Does This Matter?

Early Detection is critical to fighting and stopping cancers and many cancers are not detectable without clinical procedures.

“The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms (asymptomatic)”.**

Free/No Cost (no deductible or copay) Cancer Preventive Services such as mammograms, colonoscopes, prostate exams, etc., are commonly and frequently used today and have saved millions of lives.

Then, why are there NO Free/No Cost Skin Exam Preventive Services for Skin Cancer/Melanoma, the most common of all cancers, for anyone, even for individuals with a family history of melanoma or those over age 50 that are statistically KNOWN to have higher risk of skin cancer/melanoma?***

impactmelanoma.org/learn/are-you-risk-melanoma *** 

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OUR NEW MISSION

PUBLIC AWARENESS OF THE EXCLUSION OF SKIN EXAMS FROM PREVENTIVE SERVICES

The LAR (Lori Ann Reigert) Skin Cancer Foundation believes that skin exams are critical to saving millions of lives from skin cancer/melanoma and is determined to discover the facts, causes and remedies of the exclusion of SKIN  EXAMS from Preventive Services.

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On January 8, 2019  LARSCAF.org asked many organizations that should be concerned;

OHSU Knight Cancer Institute, MD Anderson Cancer Center, Moffit Cancer Center, Melanoma Know More Foundation, Melanoma Research Foundation, AIM at Melanoma Foundation, The Ohio State University Comprehensive Cancer Center, American Academy of Dermatology, The Skin Cancer Foundation and the American Society for Dermatological Surgery,

to provide their opinion, concern and support for our fact finding mission regarding:

1) no formal skin exam recommendations by physicians organizations*

2) the exclusion of skin exams for early detection of skin cancer/melanoma from Preventive Services (the USPSTF 2016 Report “concluded that current evidence is insufficient and that the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in asymptomatic (showing no symptoms) adults cannot be determined”.)* 

Here are UPDATES of their responses:

January 2019:

Melanoma Research Foundation - “The MRF fully supports getting comprehensive sun protection and skin checks into every household.”

LARSCAF Conclusion - The Melanoma Research Foundation is fully supportive of the LARSCAF campaign to increase public awareness regarding the exclusion of clinical skin exams from the free Preventive Services in healthcare insurance.

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February 2019:

The American Academy of Dermatologists (AAD) was very accommodating and provided a comprehensive discussion on: (1) sunscreen use for prevention, (2) skin exams for early detection of skin cancer/melanoma and (3)  the USPSTF’s exclusion of Free/No Cost clinical skin exams in Preventive Services for asymptomatic individuals.

(1) AAD on Sunscreen Use - sunscreen use is completely and comprehensively    recommended in their Position Statement.

https://www.aad.org/Forms/Policies/Uploads/PS/PS-Broad-Spectrum%20Protection%20of%20Sunscreen%20Products.pdf

(2) AAD on Skin Exams - “The AAD encourages everyone to serve as their own health advocate by regularly conducting skin self-exams. Individuals who notice any unusual spots on their skin, including those that are changing, itching or bleeding, should make an appointment with a board-certified dermatologist. In addition, individuals with an increased risk of melanoma — including men older than 50; people with more than 50 moles, or large or unusual moles; individuals with fair skin; and those with a history of skin cancer — should talk to a dermatologist about how often they should receive a skin exam from a doctor.”****

The AAD also sponsors free skin exams for all at many skin cancer events through their “SPOTme” program, which they report has been very successful in the early detection of skin cancer/melanoma:

“The SPOTme® Skin Cancer Screening Program is the AAD's longest-standing public health program. Since its inception in 1985, dermatologists have conducted more than 2.7 million free skin cancer screenings with more than 271,000 suspicious lesions detected, and more than 30,000 suspected melanomas. Millions of people have been educated about the importance of sun protection and early cancer detection through the skin cancer screening program. As a result, countless lives have been saved by identifying melanomas in their earliest, most treatable stage.” www.aad.org/public/spot-skin-cancer/programs/screenings 

 (3) AAD comments on the USPSTF/Preventive Services and the exclusion of skin exams - “the U.S. Preventive Services Task Force — a group that provides guidance for primary care physicians — has determined that there is not enough scientific evidence to make a recommendation about adults receiving skin cancer screenings from a doctor. The American Academy of Dermatology is disappointed with this recommendation, as dermatologists know that skin cancer screenings can save lives, yet we acknowledge the need for additional research on the benefits and harms of skin cancer screening in the primary care setting.”****  

“the U.S. Preventive Services Task Force — a group that provides guidance for primary care physicians — has determined that there is not enough scientific evidence to make a recommendation about adults receiving skin cancer screenings from a doctor.”****

“The American Academy of Dermatology is disappointed with this recommendation, as dermatologists know that skin cancer screenings can save lives, yet we acknowledge the need for additional research on the benefits and harms of skin cancer screening in the primary care setting.”****

“We cannot have clinical guidelines (for our dermatologists) due to the lack of evidence (of the benefit and harms of skin exams). We do not have any guidelines on how it (skin exams) should be done and on who it (skin exams) should be done on. We depend on the data and evidence just like the USPSTF (regarding skin exams). The evidence is not there for us to have clinical guidelines on it (skin exams).” 

https://www.aad.org/media/news-releases/aad-statement-on-uspstf ****

LARSCAF Conclusion:

(1) The AAD has a clear, comprehensive and formal Position Statement for unlimited sunscreen use.

(2) The AAD has no official Position  Statement(https://www.aad.org/Forms/Policies/ps.aspx) for clinical (doctor) skin exams but does recommend self skin exams for asymptomatic individuals and does recommend clinical (doctor) intervention (“talk to a doctor”*) for at risk individuals.****

(3) The AAD’s stated disappointment with the (I) “insufficient evidence” rating by the USPSTF* that prevents their recommendation of any skin exams for anyone, including at risk individuals and their statement that “dermatologists know that skin cancer screenings can save lives”* appears to conflict with the AAD’s agreement with the USPSTF, that more evidence is needed* before clinical (doctor) skin exams can be considered for asymptomatic or at even risk individuals, who they do recommend to see a doctor.****

*LARSCAF will be clarifying these terms with the AAD and the USPSTF.

AIM at Melanoma Foundation - “We applaud your mission” of increasing public awareness “of the exclusion of clinical skin exams from free cancer preventive services. Please count us among your supporters.” 

LARSCAF Conclusion - The AIM at Melanoma Foundation is fully supportive of the LARSCAF campaign to increase public awareness regarding the exclusion of clinical skin exams from the free Preventive Services in healthcare insurance.


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Reference Information

2018 physician organizations recommendations per U.S. PREVENTIVE SERVICES TASK FORCE (USPSTF)*:

https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/skin-cancer-screening2 *(2016)

https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/skin-cancer-counseling2 *(2018)

RE: SKIN EXAMS - “Recommendations by Others”:

…”The American College of Physicians has no current guidance on skin cancer screening by a clinician, nor does the College of Preventive Medicine”. 

…”The American Academy of Family Physicians concludes that current evidence is insufficient to assess the balance of benefit and harms of visual skin cancer screening in adults”.

…”The American Academy of Dermatology does not have formal guidelines on skin cancer screening”.

…”The American Cancer Society does not recommend skin cancer screening for average risk adults”.

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WHO IS THE USPSTF*?

The U.S. Preventive Services Task Force is an independent group that “makes recommendations (to the Department of Health and Human Services and the U.S. Congress) (“based on a rigorous review of existing peer-reviewed evidence”) about the effectiveness of specific clinical preventive services for patients without obvious related sign and symptoms”*

1) so that they may be considered for inclusion in the FREE/NO COST Preventive Services ** (i.e. mammograms, prostate exams, colonoscopes, etc.) for everyone with health insurance in this country and

2) are “intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient’s needs”. 

https://www.healthcare.gov/preventive-care-adults/ **

https://www.healthcare.gov/preventive-care-women/ **

https://www.medicare.gov/coverage/preventive-screening-services **

  Decision of the USPSTF 2016/2018 Regarding Skin Exams

Despite the fact that skin cancer/melanoma is the most common cancer, by far, in this country:

Clinical Skin Exams, Self Skin Exams and the General Use of Sunscreen are NOT recommended for the FREE/NO COST Preventive Services** due to insufficient evidence. 

Therefore, any time that you would want or need a clinical (doctor) skin exam YOU MUST PAY FOR IT!

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WARNING! About LARSCAF.org Recommendations

Our recommendations and promotions of clinical (doctor) skin exams for all for early Detection and survival of skin cancer/melanoma are NOT formally, medically recommended by any physician organizations and are NOT recommended by the U.S. Preventive Services Task Force to be included in the Free/No Cost cancer Preventive included in all health insurance. 

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THE RESPONSE OF SKIN EXPERTS TO THE 2016/2018 USPSTF DECISION

TO NOT RECOMMEND SKIN EXAMS

“The American Academy of Dermatology is disappointed with this “I” (insufficient evidence)recommendation (by the USPSTF), as dermatologists know that skin cancer screenings can save lives, yet we acknowledge the need for additional research…”

Full response at https://www.aad.org/media/news-releases/aad-statement-on-uspstf

American Academy of Dermatology (AAD) recommendations: aad.org

“Exposure to UV light is the most preventable risk factor for skin cancer”.

“Use sunscreen whenever you are going to be outside, even on cloudy days”. 

American Society for Dermatologic Surgery (ASDS)

“Dermatologic surgeons - who are experts in skin disease treatment - do not believe this ”insufficient evidence” recommendation is accurate”. “Screenings often lead to early detection and treatment, which lead to better outcomes and higher survival for patients”.

https://www.healio.com/dermatology/cutaneous-oncology/news/online/%7B51606be9-4f44-4e2c-8b08-a67ff02ebbb0%7D/aad-asds-express-disappointment-on-uspstf-skin-cancer-screening-statement

Expert Panel Recommends National guide Lines to Improve Melanoma Screening (2017)

“despite research showing that a total body skin examination is the safest and most economical melanoma screening method, how to implement it is left to primary healthcare institutions”

https://melanomanewstoday.com/2017/03/28/experts-suggest-national-melanoma-screening-guidelines-needed/

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