Athens, Greece — A compelling debate unfolded at the 11th World Congress of Melanoma and 21st EADO Congress 2025, where dermatology experts tackled the controversial issue of population-wide skin cancer screening. Should we be screening everyone, or should efforts focus on high-risk individuals only? The answers were far from unanimous.
Two Sides of the Same Coin
On one side of the discussion stood Dr. Susana Puig, head of Dermatology at Hospital Clínic de Barcelona. Puig argued firmly against broad screening programs—especially in countries with lower to moderate skin cancer incidence like Spain.
“It’s not efficient. We visit too many healthy individuals to detect melanoma,” Puig emphasized. “We need to focus on treating patients, not checking healthy people without any risk.”
She cited data from Germany showing that screening over 600 individuals (or 559 if starting at age 35) is required to detect just one melanoma—raising concerns about overdiagnosis, misallocated resources, and the strain on healthcare systems.
The Risk of Overdiagnosis
Puig’s concerns echo findings in the U.S., where melanoma incidence has skyrocketed sixfold over 40 years, yet mortality rates have remained stable. This pattern suggests that many melanomas detected may not pose serious threats—a classic sign of overdiagnosis, as noted by Dr. Adewole Adamson from the University of Texas.
Rather than casting the net wide, Puig championed a targeted approach. By identifying and prioritizing high-risk individuals—those with a personal or family history of melanoma, atypical moles, or advanced age—the efficiency and impact of screening could be dramatically improved.
She noted that people over 70 are 93 times more likely to be diagnosed with melanoma compared to those under 30, and screening high-risk groups reduces the number needed to screen from 600 to just 178.
Her solution? Dedicated surveillance programs for at-risk individuals, and opportunistic screening during routine healthcare visits.
The Case for Screening Everyone
On the other side, Dr. Peter Mohr, a dermatologist from Elbe Klinikum Buxtehude in Germany, made the case for broad-based screening, arguing that prevention must take center stage.
“The ultimate goal of screening,” Mohr said, “is to prevent advanced disease and reduce melanoma-specific mortality.”
Mohr cited a large retrospective study in Germany involving 1.4 million people. The findings were striking: among those screened, there were significant reductions in:
- Locoregional metastasis (13% → 4%)
- Distant metastases (8% → 4%)
- Need for systemic treatments (21% → 11%)
These benefits translated to better survival outcomes for the screened group.
He acknowledged the lack of large randomized trials on the subject but stressed that Germany is uniquely positioned for population-wide screening due to its robust dermatology infrastructure, strong public awareness campaigns, and short wait times for dermatological assessments—averaging 6 weeks for general screening and just 1.2 weeks for suspicious lesions.
Can Primary Care Bridge the Gap?
Despite their disagreements, Puig and Mohr both recognized the crucial role of primary care physicians in early melanoma detection.
In Spain, general practitioners are supported by teledermatology and dermoscopy training, with dermatologists responding to online consultations within a week—slashing the need for in-person visits by 50%.
In Germany, an 8-hour training course significantly boosted diagnostic accuracy among GPs, although Mohr cautioned that these skills may diminish without ongoing education.
Conclusion: A Nuanced Path Forward
So, what’s the answer? The debate suggests there may not be a one-size-fits-all solution. Puig makes a strong case for precision screening in lower-risk regions, while Mohr highlights real-world evidence that mass screening can save lives—at least in well-resourced systems like Germany’s.
What both sides agree on is this: early detection matters, and empowering primary care providers may be the most universally effective step we can take right now.
