Skin Cancer Screening Programs: Are They Effective?

An anticipated 91,270 Americans will receive a diagnosis of malignant melanoma this year, and 9320 will die of the disease, according to the US National Cancer Institute.¹ Incidence rates have climbed steadily in recent decades but there have been modest reductions in mortality since 2006, likely due in part to advances in targeted treatment options. The 5-year overall survival rate in the United States exceeds 90%.¹ Melanoma incidence rates rose by 1.5% a year, on average, between 2006 and 2015 — but mortality rates declined by 1.2% per year during the same period.¹

Skin cancer screening programs are intended to improve the chances of early detection and treatment of melanoma, but the evidence that they achieve that goal remains mixed.^2,3 As a result, skin cancer screening recommendations vary between countries.^4,5 The US Preventive Services Task Force (USPSTF) concluded in 2016 that the available research offered insufficient evidence to determine the potential harms — such as anxiety or overtreatment — and benefits of clinician-conducted visual skin cancer-screening examinations.² Several US medical societies, including the American College of Physicians, American College of Preventive Medicine, and the American Cancer Society, do not recommend skin cancer screening.⁶  

Germany established the world’s first nationwide skin cancer screening program in 2008, yielding a modest and temporary drop in melanoma mortality.⁵ By 2014, the program had not achieved a decrease from 2007 melanoma mortality rates.⁵

In the United States, the American Academy of Dermatology’s SPOTme^® Skin Cancer Screening Program has provided more than 2 million no-fee, volunteer-led skin cancer screenings since it was established in 1985, leading to the detection of more than 30,000 suspected melanomas.⁶ It is one of the largest cancer screening programs, second only to the US Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program.⁶

A recent review of the SPOTme program’s first 30 years of operation found that participating clinicians have performed approximately 100,000 screenings each year since 1990.⁶ That program has led to detection and diagnosis of melanomas among thousands of people, including the 9% of screenees overall — and 12% of those with a melanoma diagnosis — who were uninsured.⁶

“In all, 72% of the screenees met the US Prevention Services Task Force criteria for high risk of melanoma,” the researchers reported.⁶ “Among persons with clinically diagnosed melanoma, 47% would not have otherwise seen a doctor for a skin examination.”