Roadmap for a National Targeted Skin Cancer Screening Program

Melanoma is Australia’s third most common invasive cancer, and two-thirds of Australians will be diagnosed with non-melanoma skin cancers (also known as keratinocyte skin cancers such as basal cell and squamous cell carcinomas) in their lifetime.

When detected in its earliest stages, long term survival rates for melanoma are greater than 95%. Early identification and treatment of keratinocyte skin cancers can also reduce the need for invasive treatments and the risk of complications.

Skin checks are an important tool in the early detection of skin cancers, however the current approach to skin cancer screening in Australia is ad hoc and inequitable in its reach. It predominantly relies on individuals or their doctors to identify who is at risk and initiate skin checks. This current opportunistic approach to the early detection of skin cancer has led to many individuals who would benefit from having regular skin checks not having them, and others having skin checks despite little potential benefit.

For example, some people at high risk of skin cancer may be unable to easily access a skin check (at a GP, skin cancer clinic or dermatologist) because of living and working in rural and remote areas or because of financial or other reasons. Conversely, for people at low risk of skin cancer, the potential harms or inconveniences of having a skin check might outweigh the potential benefits. Potential harms or inconveniences include removal or biopsy of non-cancerous or low risk lesions, which take time to heal and can come with risks of infection, anxiety for patients, financial costs for the individual and the health system, and time away from work or family. There are also currently no clear guidelines or clinical quality frameworks for skin checks, and this can lead to significant variability in the care received.

Melanoma Institute Australia, and many others in the Australian skin cancer community, have long recognised that we need to get better at working out how to identify lesions of concern, which lesions to remove and when, and have advocated for a more systematic, targeted and equitable approach to skin cancer screening in Australia.

As a result, the Australian Government recently announced a budget allocation of about $10 million for the development of a Roadmap for a National Targeted Skin Cancer Screening Program – of this a $7.5 million grant was awarded to Melanoma Institute Australia in January 2025 to lead the development of the Roadmap. A further $2 million has been awarded to the Australian Institute of Health and Welfare to develop the data collection and monitoring needs to support the development and potential implementation a national, targeted skin cancer screening program.

The Roadmap will set out an evidence-based program for screening that would target those in the population at highest risk, and would be equitable in its reach, trustworthy for patients and clinicians and cost-effective for the community and the healthcare system.

As outlined in a recent perspective piece in the Medical Journal of Australia authored by a clinical and research team at Melanoma Institute Australia, the introduction of an organised, accurate melanoma screening program that is targeted to individuals most at risk while minimising harm requires consideration of many factors and the evaluation of evidence to answer several key questions.

These questions centre around determining who should be screened; what methods should be used to examine the skin; when people should be screened and how frequently; where screening should take place and how to optimise and standardise the referrals to specialist care. Along with this are considerations of the workforce training and accreditation needs and the funding that is required to ensure nationally consistent quality care.

Over the next three and a half years, Melanoma Institute Australia will work in collaboration with Cancer Australia, the Australian Institute of Health and Welfare, clinicians, researchers, consumers, primary health care networks, states and territories and a range of other stakeholders to gather the evidence and answer these questions. Consultation with all stakeholders will take place throughout the program to gather broad insights and feedback from everyone with an interest or stake in a screening program.

The resulting Roadmap recommendations will form an evidence-based blueprint to be delivered to the Australian Government that will identify the most appropriate risk assessment tools to identify who would be invited for screening, what the screening intervention would be, and how screening would be delivered. Recommendations will also be made for how those who are identified as having a potentially concerning lesion would be clinically assessed and followed up. Assessments will be made in relation to how the benefits of the screening program could be maximised and the potential harms minimised. The required infrastructure, data management, funding mechanisms and health economic modelling will also be examined to ensure a feasible, robust, and cost-effective screening program could be rolled out.

Professor Anne Cust, co-lead of the Prevention, Risk & Clinical Detection of Melanoma research stream at Melanoma Institute Australia (and also based at the Daffodil Centre, a partnership between the University of Sydney and Cancer Council NSW), will lead the program on behalf of Melanoma Institute Australia. Work is well underway to establish the Governance and Workstreams for the program and gather the necessary experts and community leaders with whom Melanoma Institute Australia will collaborate closely to deliver the Roadmap. The work is expected to be fully underway by March 2025.

National Roadmap for Skin Cancer Screening – an Australian Government initiative.