Routine Yearly Skin Checks with Dermatology
For average-risk adults, routine yearly skin checks with a dermatologist are recommended starting at age 40, while those at high risk should be referred to dermatology for regular monitoring regardless of age.
Age-Based Screening Recommendations for Average-Risk Individuals
The American Cancer Society recommends a cancer-related checkup including skin examination every three years for patients between ages 20 and 40, and yearly for anyone age 40 and older 1. This represents the most specific age-based guidance available from major medical organizations.
For patients ages 20-40:
- Skin examination every 3 years as part of cancer-related checkup 1
- Monthly self-examinations recommended 1
For patients age 40 and older:
Important Caveats About Evidence Quality
The USPSTF and Canadian Task Force on Preventive Health Care both concluded there is insufficient evidence to recommend for or against routine screening for skin cancer in average-risk, asymptomatic individuals 1. These organizations note that while melanoma incidence is increasing (primarily early-stage lesions likely from screening), mortality has not changed substantially, raising questions about screening effectiveness 1.
Despite this lack of definitive mortality benefit data, the American Cancer Society's age-based recommendations provide practical guidance for clinical practice 1.
High-Risk Patients Requiring Dermatology Referral
High-risk patients should be referred to a dermatologist for monitoring and screening examinations at any age 1. High-risk criteria include:
- Familial melanoma syndrome 1
- First-degree relative with melanoma 1
- Personal history of melanoma 2
- History of treated actinic lesions 2
- Multiple atypical nevi 3
- Sun-sensitive skin types 2, 4
Moderately Increased Risk Patients
The American Medical Association recommends annual skin examinations by a primary care physician for patients at moderately increased risk 1. These patients should discuss screening frequency with their physician and perform monthly self-examinations 1.
Clinical Pearls for Risk Assessment
When evaluating whether to recommend dermatology referral, assess for:
- ABCDE criteria for suspicious lesions: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution over time 3
- "Ugly duckling" sign: Moles that look different from surrounding moles 3
- Sun exposure history: History of severe burning increases risk 5
- Family history of skin cancer 5, 4
Common pitfall: Melanomas can occur in non-sun-exposed areas, particularly in people with darker skin, who are often diagnosed at later stages 3. Don't limit examination to sun-exposed areas only.
Practical Implementation
For patients with no specific risk factors, the American Cancer Society's framework provides actionable guidance: begin screening every 3 years at age 20, transition to annual screening at age 40 1. However, maintain a low threshold for dermatology referral when patients have concerning lesions or multiple risk factors, as complete skin examinations detect melanoma 6.4 times more frequently than partial examinations 1.