Note: The Overview section summarizes the published evidence on this topic. The rest of the summary describes the evidence in more detail.
Other PDQ summaries containing information related to skin cancer screening include the following:
The only widely proposed screening procedure for skin cancer is visual examination of the skin, including both self-examination by the patient and clinical examination by the health care provider. Mobile phone applications that evaluate skin lesions to detect skin cancer and malignant melanoma have been launched.[1] However, the use of such applications to assess skin cancer has been problematic because of the lack of evidence of their diagnostic accuracy and because they have not been studied in large-scale screening programs.[2-4] The use of convolutional neural networks to classify images of melanoma and skin cancer is a growing area of research.[5-7]
There is insufficient evidence that population screening for skin cancer reduces skin cancer mortality. The evidence is inadequate to determine whether visual examination of the skin in asymptomatic individuals leads to a reduction in mortality from melanomatous skin cancer. Further, in asymptomatic populations, the effect of visual skin examination on mortality from nonmelanomatous skin cancers is unknown.
Magnitude of Effect: Unknown.
Based on fair—though unquantified—evidence, visual examination of the skin in asymptomatic individuals may lead to adverse consequences. These consequences include complications of diagnostic or treatment interventions (such as poor cosmetic or functional outcomes) and the psychological effects of being labeled with a potentially fatal disease. Other harmful consequences are overdiagnosis, leading to the detection of biologically benign disease that would otherwise go undetected, and possible misdiagnosis of a benign lesion as malignant.
Magnitude of Effect: Unknown.
There are two main types of skin cancer:
BCC and SCC are the most common forms of skin cancer but have substantially better prognoses than the less common, generally more aggressive melanoma.
Keratinocyte carcinoma is the most commonly occurring cancer in the United States. Its incidence appears to be increasing in some [1] but not all [2] areas of the United States. Overall U.S. incidence rates have likely been increasing for a number of years.[3,4] At least some of this increase may be attributable to increased skin cancer awareness and resultant increasing investigation and biopsy of skin lesions. A precise estimate of the total number and incidence rate of keratinocyte carcinoma is not possible because reporting to cancer registries is not required. However, it was estimated that in 2012, 5.4 million cases of keratinocyte carcinoma were diagnosed among 3.3 million people in the United States.[5] That number exceeds all other cases of cancer estimated by the American Cancer Society for 2024, which is about 2 million.[5]
Melanoma is reportable in U.S. cancer registries, so there are more reliable estimates of incidence than for keratinocyte carcinoma. In 2024, it is estimated that 100,640 individuals in the United States will be diagnosed with invasive melanoma and 99,700 will be diagnosed with melanoma in situ. Approximately 8,290 individuals will die of melanoma in 2024. Since the early 2000s, melanoma incidence rates among individuals younger than 50 years have stabilized in women but declined by about 1% per year in men. However, among individuals aged 50 years and older in recent years, the incidence rates appeared to have stabilized in men but increased by about 3% per year in women.[5] From 2013 to 2017, melanoma mortality rates declined by 6% to 7% per year in both men and women.[5]
A study of skin biopsy rates in relation to melanoma incidence rates obtained from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute indicated that much of the observed increase in incidence between 1986 and 2001 was confined to local disease and was most likely caused by overdiagnosis as a result of increased skin biopsy rates during this period.[6] A second study that used SEER data between 2002 and 2009 reported similar findings.[7]
The incidence of melanoma also increased in children and adolescents until 2002. However, between 2002 and 2019, there was a 4.3% reduction in the yearly incidence rate of melanoma among children and adolescents in the National Childhood Cancer Registry databases.[8] During that time, the average annual incidence in this group was exceptionally low (4.7 per 1 million), which may have resulted in spurious trends.[8] Nevertheless, similar trends have been seen in Sweden.[9] In the U.S. study of pediatric melanoma, nearly one-half of the patients had local disease (22% of patients had in situ disease, and 25% of patients had superficial spreading), and nearly one-half of the patients had disease with a thickness of less than one millimeter. Given that mortality from pediatric melanoma had been fairly stable during those years,[10] it is likely that the increase in incidence could be explained, at least in part, by overdiagnosis.
Epidemiological evidence suggests that exposure to UV radiation and the sensitivity of an individual’s skin to UV radiation are risk factors for skin cancer, although the type of exposure (high-intensity and short-duration vs. chronic exposure) and pattern of exposure (continuous vs. intermittent) may differ among the three main types of skin cancer.[1-3] In addition, genetic predisposition and the immune system may play roles in the pathogenesis of skin cancers.[4] Organ-transplant recipients receiving immunosuppressive drugs are at elevated risk of skin cancers, particularly squamous cell carcinoma (SCC). Arsenic exposure also increases the risk of cutaneous SCC.[5,6]
The incidence of melanoma rises rapidly in White individuals after age 20 years. Fair-skinned individuals exposed to the sun are at higher risk. Individuals with certain types of pigmented lesions (dysplastic or atypical nevi), with several large nondysplastic nevi, many small nevi, or moderate freckling have a twofold to threefold increased risk of developing melanoma.[7] Individuals with familial dysplastic nevus syndrome or with several dysplastic or atypical nevi are at high (>fivefold) risk of developing melanoma.[4,7]
It is important to note that, for the general population, most melanomas may not arise from preexisting nevi. A meta-analysis of studies published between 1948 and 2016 found that the prevalence of nevus-associated melanomas was only 29%, compared with 71% for the prevalence of de novo melanomas.[8]
Observer variability among physicians has been noted in the evaluation of skin lesions and subsequent biopsy specimens. A systematic review of 32 studies that compared the accuracy of dermatologists and primary care physicians in making a clinical diagnosis of melanoma concluded that there was no statistically significant difference in accuracy. However, the results were inconclusive, owing to small sample sizes and study design weaknesses.[1] Subsequent studies have noted a higher accuracy for dermatologists in the diagnosis of melanocytic lesions,[2,3] yet there is a shortage of dermatologists to meet the demands of population-level screening.
A study of 187 pathologists who practiced in the United States found that cases of moderately dysplastic nevi to early-stage invasive melanoma had less than 50% agreement with a reference diagnosis defined by consensus of experienced pathologists.[4] At a U.S. population level, it is estimated that 82.8% (95% confidence interval, 81.0%–84.5%) of melanocytic skin biopsy diagnoses would be verified if they were reviewed by a consensus reference panel of experienced pathologists.[4] In addition, differentiating between benign and malignant melanocytic tumors during histological examinations of biopsy specimens has been shown to be inconsistent, even in the hands of experienced dermatopathologists.[5,6] This variability in the diagnosis of melanocytic lesions undermines the results of studies that examine screening effectiveness and also may undermine the effectiveness of any screening intervention. Furthermore, this finding suggests that requesting a second opinion regarding the pathology of biopsy specimens may be important.[5-7] A standardized approach to pathologists’ classifying of the interpretations of melanocytic skin lesions may also reduce confusion and improve communication between clinicians.[4,6,8,9]
More than 90% of melanomas that arise in the skin can be recognized with the naked eye. Very often there is a prolonged horizontal growth phase, during which the tumor expands centrifugally beneath the epidermis but does not invade the underlying dermis. This horizontal growth phase may provide lead time for early detection. Melanoma is more easily cured if treated before the onset of the vertical growth phase with its metastatic potential.[1]
The probability of tumor recurrence within 10 years after curative resection is less than 10% with tumors less than 1.4 mm in thickness. For patients with tumors less than 0.76 mm in thickness, the likelihood of recurrence is less than 1% in 10 years.[2]
A systematic review of skin cancer screening examined evidence available through mid-2005. The review concluded that direct evidence of improved health outcomes associated with skin cancer screening is lacking.[3] An updated review published in 2016 found limited evidence that skin cancer screening reduces melanoma mortality.[4,5]
No randomized trials evaluating the efficacy of skin cancer screening on mortality have been completed. A population-based trial (using cluster randomization) to determine the effect of skin cancer screening on melanoma mortality was initiated in Queensland, Australia, but lost its funding after the initial pilot phase, and no health outcomes were ever reported.[6]
Two ecological studies have been conducted using data from Germany. The first study was a pilot project conducted in 2003 and 2004, in which a skin cancer screening program was implemented in one federal state. Suggestion of a reduction in melanoma mortality with screening led to the establishment of countywide skin cancer screening programs in 2008.[7,8] The programs offered a whole-body skin exam once every 2 years for individuals older than 35 years. The second ecological study compared the melanoma mortality experience in Germany with the melanoma mortality experience of subregions of 22 European countries—none of which had organized screening programs—for the years 2000 to 2013. After adjustment for potential confounders, Germany and the 22 European regions had similar malignant mortality rates, suggesting no benefit of screening.[9]
Harms have not been well studied or reported in quantitative terms, but the potential for adverse consequences from skin cancer screening exists. In the SCREEN pilot project in Germany, 4.4% of all screened participants underwent a skin excision for a suspicious lesion, but the majority of biopsies did not result in a cancer diagnosis. The detection rate was especially affected by age. 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.[1]
Visual examination of the skin in asymptomatic individuals may lead to cosmetic or functional complications of diagnostic or treatment interventions and the psychological effects of being labeled with a potentially fatal disease, although robust data on the frequency of such events are lacking. Other harmful consequences are overdiagnosis, leading to the detection of biologically benign disease that would otherwise go undetected,[2-4] and possible misdiagnosis of a benign lesion as malignant. For more information, see the Accuracy of Making a Clinical Diagnosis of Melanoma section.
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.
Incidence and Mortality of Skin Cancer
Added American Cancer Society as reference 5.
Updated statistics with estimated new cases of melanoma and melanoma in situ and deaths due to melanoma for 2024. Also revised text to state that among adults aged 50 years and older in recent years, the incidence rates appeared to have stabilized in men but increased by about 3% per year in women. From 2013 to 2017, melanoma mortality rates declined by 6% to 7% per year in both men and women.
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This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about skin cancer screening. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.
This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
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The preferred citation for this PDQ summary is:
PDQ® Screening and Prevention Editorial Board. PDQ Skin Cancer Screening. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/skin/hp/skin-screening-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389300]
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