Population vs Tailored Skin Cancer Screening: Which Is Best?

ATHENS, Greece — At the 11th World Congress of Melanoma and 21st EADO Congress 2025, experts presented divergent perspectives on the merits of population-wide skin cancer screening programs vs more targeted approaches. The debate highlighted concerns about healthcare resource allocation, overdiagnosis, and the true impact of mass skin cancer screening on mortality.

Arguing against widespread screening, particularly in low-to-medium incidence countries like Spain, was Susana Puig, MD, the head of Dermatology at Hospital Clínic de Barcelona, University of Barcelona, and a dermatologist at Barnaclínic+, Barcelona, Spain.

“It’s not efficient. We visit too many healthy individuals to detect melanoma,” she said. “We need to focus on treating patients, not checking healthy people without any risk.”

Championing for population-wide screening was Peter Mohr, MD, a dermatologist at the Clinic of Dermatology in Elbe Klinikum Buxtehude, Buxtehude, Germany, who noted a disproportionate focus on treatment rather than prevention. “The ultimate goal of screening,” he said, “is to prevent advanced disease and reduce melanoma-specific mortality.”

Avoid Population-Based Screening

Presenting data from Germany, Puig noted that population-based screening starting at any age requires examining more than 600 people and performing over 24 excisions to detect one melanoma. When setting screening to start at the age of 35 years, the number of people needed to screen to detect one melanoma decreased slightly to 559. 

These findings highlight that population-based screening will include many people who don’t need it and can increase the potential for overdiagnosis, she argued.

Studies and guidelines from the United States align with Puig’s concern about broad-based screening likely leading to overdiagnosis. “The incidence of melanoma has risen sixfold in the past 40 years in the United States, while mortality has remained largely flat, an epidemiological signature consistent with overdiagnosis,” according to Adewole Adamson, MD, an assistant professor of internal medicine, in the Division of Dermatology at Dell Medical School at The University of Texas at Austin, Texas, who published findings to this effect in 2022.

“We cannot saturate the system with healthy people,” Puig said. Instead, “we need to use strategies to identify high-risk patients.” She proposed being more selective about who to screen by identifying those at higher risk of developing melanoma.

Identifying risk factors, such as the presence of atypical nevi and a personal or family history of melanoma, can help hone who is screened, she explained. Patients with a personal history of melanoma, in particular, face a higher risk of developing subsequent melanomas. Data show that patients with two or more primary melanomas had almost three times the risk of developing a subsequent one than those with one prior melanoma — 25.7% vs 8.6%. Puig also pointed out the significant correlation between age and melanoma risk, with people over 70 years exhibiting a 93-fold higher probability of diagnosis than those younger than 30 years.

Citing the German data, she noted that screening people 20 years and older with one risk factor reduced the number needed to screen by more than threefold — from more than 600 to 178.

Puig suggested dedicated surveillance programs for high-risk individuals alongside opportunistic screening during routine medical encounters.

“This would lead to a more efficient allocation of healthcare resources and better outcomes for those most vulnerable to melanoma,” Puig concluded.

Perform Population-Based Screening

In contrast, Mohr presented a defense of population-based skin cancer screening. Skin cancer is the most common cancer diagnosed in the United States and is prevalent worldwide, with more than 1.5 million new cases diagnosed globally in 2022.

Screening people and identifying the disease in its earliest stages is important, he said.

Mohr highlighted a recent study exploring biennial skin cancer screening in Germany and found that 4.2% of those screened had a skin cancer finding, but the number of interval melanomas was similar in both screened and unscreened populations.

However, a large retrospective cohort study from Germany involving about 1.4 million people showed a decrease in locoregional metastasis (from 13% to 4%), distant metastases (from 8% to 4%), and systemic treatments (from 21% to 11%) in screened vs unscreened people, as well as better overall survival rates in the screened population.

Mohr highlighted how Germany, in particular, is well-equipped for more broad-based, preventative screening.

Germany has had long-standing primary prevention programs, which have existed for about 24 years and involve extensive public awareness campaigns. Access to dermatologists is significantly better in Germany compared with the Netherlands, with an average waiting time for screening of around 6 weeks and only 1.2 weeks for suspicious lesions, compared with 14 weeks and 3.5 weeks, respectively, in the Netherlands. This access may make a broader screening strategy more feasible in a country like Germany.

However, Mohr did note that there are “no large, randomized trials to show us the value of skin cancer screening.”

A Role for Primary Care Physicians?

Although they disagreed about the utility of screening, both Puig and Mohr agreed on the important role primary care physicians play in improving early melanoma detection. “We cannot do it alone, and general practitioners are really fundamental,” Puig said.

Mohr said that continuous education for primary care physicians can dramatically improve their diagnostic skills. In Germany, an 8-hour training session significantly improved their ability to detect basal cell carcinoma and melanomas. However, he cautioned that this improved accuracy tended to wane within a year.

In Spain, Puig highlighted the successful implementation of teledermatology to support general practitioners. “We train them with dermoscopy, and we answer all teledermatology requests in 1 week, reducing in-person visits by 50%,” she explained. This approach allows general practitioners to assess potential skin cancer efficiently and streamline referrals.

Puig reported being on advisory boards for Almirall, Bristol Myers Squibb (BMS), ISDIN, La Roche-Posay, Leo Pharma, Novartis, Pfizer, Regeneron, Roche, Sanofi, and Sun Pharma. She conducts research and trials with AbbVie, Almirall, Amgen, BMS, Biofrontera, Canfield, Cantabria, Fotofinder, GSK, ISDIN, La Roche-Posay, Leo Pharma, MSD, MEDA, Novartis, Pfizer, Polychem, Sanofi, Roche, and Regeneron. She is involved with Athena Technology Solutions and Dermavision Solutions. Mohr reported no relevant financial relationships.

Manuela Callari is a freelance science journalist specializing in human and planetary health. Her work has been published in The Medical Republic, Rare Disease Advisor, The Guardian, MIT Technology Review, and others.