From the Guidelines
All individuals with a high risk for skin cancer, including those with fair skin, a personal or family history of skin cancer, numerous or atypical moles, significant sun exposure, or compromised immune systems, should see a dermatologist annually for skin cancer screening. This recommendation is based on the understanding that certain populations are at a substantially increased risk for melanoma and other skin cancers, as noted in the 2009 U.S. Preventive Services Task Force recommendation statement 1. Key factors that increase the risk for skin cancer include being fair-skinned, having a history of sun exposure or sunburns, and having more than 50 moles or atypical moles.
Identifying High-Risk Populations
- Fair-skinned men and women older than 65 years are at a higher risk for melanoma.
- Patients with atypical moles or more than 50 moles are considered high-risk.
- A family history of skin cancer and significant sun exposure or sunburns also increase the risk.
- Individuals with compromised immune systems, such as those with HIV/AIDS, organ transplant recipients, or those on immunosuppressive medications, are at a higher risk.
Importance of Annual Screenings
Annual screenings by a dermatologist are crucial for the early detection of skin cancers, which significantly improves treatment outcomes. Between professional screenings, individuals should perform monthly self-examinations and adhere to sun protection measures, including the use of broad-spectrum sunscreen (SPF 30+), wearing protective clothing, and avoiding peak sun hours.
Additional Considerations
Certain genetic conditions, such as xeroderma pigmentosum or familial atypical multiple mole melanoma syndrome, require more frequent and vigilant monitoring. The U.S. Preventive Services Task Force has previously reviewed the evidence for counseling to prevent skin cancer, and their recommendations are available on the AHRQ Web site, as mentioned in the study 1. While the benefits from screening are uncertain even in high-risk patients, the potential for early detection and improved outcomes supports the recommendation for annual screenings in these populations.
From the Research
Patient Population for Annual Skin Cancer Screening
The following patient populations should consider seeing a dermatologist annually for skin cancer screening:
- Individuals with a personal history of melanoma, as they are at increased risk for disease recurrence and second primary melanomas 2
- Those with a family history of skin cancer, particularly first-degree relatives with melanoma, as this increases the lifetime risk of melanoma, squamous cell carcinoma, and basal cell carcinoma 3, 4
- Patients with a history of cutaneous squamous cell carcinoma, as family history of skin cancer is an important independent risk factor for this type of cancer 3
Risk Factors for Skin Cancer
Certain risk factors increase the likelihood of developing skin cancer, including:
- UV radiation exposure, especially in childhood 5
- Fair skin and other pigmentary characteristics 4
- Environmental factors, such as sunburn and indoor tanning 5
Screening Recommendations
While there is no consistent evidence that behavioral interventions reduce the frequency of sunburn or skin cancer outcomes, annual skin cancer screening is still recommended for high-risk populations, including those with a personal or family history of skin cancer 2, 5, 4