Skin Cancer: Screening and Prevention

Skin cancer is the most common cancer in the United States. Basal cell carcinoma, the leading type of skin cancer across all racial and ethnic groups, is usually slow growing and curable. Cutaneous squamous cell carcinoma accounts for more skin cancers in individuals with darker skin tones. Cutaneous melanoma is less common but potentially lethal in later stages. Patients with darker skin tones may have melanoma diagnosed at later stages, contributing to worse outcomes. Exposure to UV radiation is the primary risk factor for developing skin cancer. The US Preventive Services Task Force found insufficient evidence to recommend for or against routine visual skin cancer screening in asymptomatic adolescents and adults. Use of smartphone apps is not recommended because they are unreliable for detection. Artificial intelligence tools and teledermatology show promise for triage and access but are not yet standard for population-level skin cancer screening. Sun protection through public education, topical sunscreen application, UV protective clothing, and sun avoidance during peak UV hours remains the mainstay of skin cancer prevention. Oral nicotinamide reduces new nonmelanoma skin cancers in high-risk immunocompetent patients. Other chemopreventive agents, such as systemic retinoids, may be considered in select high-risk patients but are limited by adverse effects.