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.
Nelson M, Hamel RK, Nash J. Skin Cancer: Screening and Prevention. FP Essent. 2026;564:6-13.
Case 1. SH is a healthy 45-year-old man with fair skin (Fitzpatrick skin type I) who presents to your clinic for a health maintenance visit. He has had significant sun exposure with inconsistent sun protection and a family history of melanoma in his father. His skin shows moderate photodamage. He asks if he needs to see a dermatologist for a preventive skin examination.
Epidemiology
Skin cancer is the most common cancer in the United States, with a lifetime risk of 1 in 5.1,2 Skin cancers are broadly categorized into nonmelanoma skin cancers and cutaneous melanoma. The incidence is rising because of increased UV radiation exposure (due to sun exposure and tanning bed use), an aging population, and improved detection.2–4
Basal cell carcinoma and cutaneous squamous cell carcinoma are the main types of nonmelanoma skin cancer. Basal cell carcinoma is linked to intense, intermittent UV exposure, whereas cutaneous squamous cell carcinoma is associated with repeated, cumulative sun exposure over decades.1,5 Cutaneous squamous cell carcinoma is uncommon before 50 years of age, but basal cell carcinoma can occur as early as the 20s or 30s.1,4
Melanoma incidence in the United States increased substantially in White patients between 1975 and 2016, from 11.3 to 54.7 cases per 100,000 men and from 9.5 to 32.8 cases per 100,000 women.6 Although Black individuals have a lower overall incidence of melanoma, the stage at diagnosis is more likely to be later, contributing to worse outcomes.7–9 Although melanoma is not as common as other skin cancer types, it is one of the most lethal types of skin cancer.8
KERATINOCYTE CARCINOMAS
Keratinocyte carcinomas, including basal cell carcinoma and cutaneous squamous cell carcinoma, are nonmelanoma skin cancers and represent the most common forms of skin cancer. Basal cell carcinoma accounts for approximately 80% of cases and cutaneous squamous cell carcinoma for 20%.4,10,11 In the United States, an estimated 3.3 million cases of basal cell carcinoma are treated annually. The incidence of squamous cell carcinoma is roughly 1 million cases annually.12,13 Historically, nonmelanoma skin cancers have not been tracked in national cancer registries, making surveillance difficult and incidence estimates reliant on insurance claims and regional data.13
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