Table 4. . Comparison of international skin cancer screening and counseling guidelines .
| Organization | Guidelines | Population | Frequency | Counseling | Ref. |
|---|---|---|---|---|---|
| Australia & New Zealand | |||||
| CCA and Australasian College of Dermatologists | Routine TBSE | ‘High-risk’ patients, defined as: – Fair skin, light eyes, light or red hair – Tendency to burn – Freckles – Increased number of dysplastic nevi – Immunosuppression – FH of melanoma in first degree relative – PH of melanoma or KC |
Every 3–12 months | How to detect lesions suspicious for melanoma and when to seek advice from medical practitioner | [60] |
| NHMRC (with the CCA and the New Zealand Ministry of Health) | Routine TBSE (grade B†) | ‘High-risk’ patients, assessed by: – Skin/hair color – Sun sensitivity – Number of common and atypical nevi – Chronic actinic skin damage – FH of melanoma – PH of melanoma or KC – Age and gender |
Every 6 months | How to detect lesions that are suspicious for melanoma | [61] |
| Royal Australian College of General Practitioners | Routine TBSE | ‘High-risk’ patients, defined as: – >6-fold increased risk of melanoma: – Multiple dysplastic nevi – FH of melanoma in first-degree relative – PH of melanoma |
Every 3–12 months | How to detect lesions suspicious for skin cancer and how to prevent skin cancer | [62] |
| Opportunistic skin examinations | ‘Average or increased risk’ patients, defined as two- to fivefold increased risk of melanoma | Opportunistically | |||
| The UK | |||||
| British Association of Dermatologists | Routine TBSE (grade B†) | ‘Moderately increased risk’ patients: – Clinically atypical nevi – Large number of nevi – PH of melanoma |
Interval undefined Refer to specialist |
[63] | |
| ‘Greatly increased risk’ patients: – Giant congenital nevi |
Interval undefined Lifetime monitoring |
||||
| FH of melanoma in 3 or more members or FH of pancreatic cancer | Interval undefined Refer to specialist |
||||
| The Netherlands | |||||
| Dutch Working Group on Melanoma | Routine TBSE | At risk patients: – 5 or more atypical nevi – 100 or more common nevi |
Annually | How to perform an SSE and identify risk factors | [64] |
| First-degree relatives with diagnosis of familiar melanoma/FAMMM syndrome or CDKN2A mutation | 1–2-times per year (starting at 12 years) | ||||
| Second-degree relatives with known CDKN2A mutation | 1–2-times per year (starting at 20 years) | ||||
| Germany | |||||
| Germany | Routine TBSE | All adults age 35 years or older with health insurance | Every 2 years | [65] | |
| German Guideline Program in Oncology | Routine TBSE (EC) | At risk patients, assessed by: – Skin type – Chronic actinic skin damage – Number of acquired or atypical nevi – Large congenital nevus – Immunosuppression – FH of melanoma – PH of melanoma, AK or KC |
Determined by physician and patient | How to detect lesions suspicious for skin cancer and how to perform SSE | [66] |
†Most organizations recommend screening only at-risk individuals. Notice how most of the above recommendations are based risk factors. Germany is the only country that offers whole-population screening.
Grade B: Body of evidence can be trusted to guide practice in most situations [61].
AK: Actinic keratosis; CCA: Cancer Council Australia; EC: Expert opinion; FAMMM: Familial Atypical Multiple Mole Melanoma Syndrome; FH: Family history; KC: Keratinocyte carcinoma; NHMRC: National Health and Medical Research Council; PH: Personal history; SSE: Self-skin exam; TBSE: Total body skin examination.