Population Skin Cancer Screening and Melanoma Mortality Rates.

Abstract

In Germany, a population-based skin cancer screening (SCS) program was implemented in 2008. The benefit of the intervention is unclear. To determine whether the German SCS program was associated with reduced melanoma mortality. This population-based, ecological comparative effectiveness study compared trends in melanoma mortality from 2009 to 2022 in Germany with those in neighboring countries without population-based SCS using data on melanoma mortality from the official cause-of-death statistics. The total populations of 15 federal states of Germany and 9 neighboring countries were examined. The German federal state of Schleswig-Holstein was excluded from the analysis due to a potential lasting effect of a preceding pilot project, conducted in 2003 and 2004. Data were analyzed from November 7, 2025, to February 11, 2026. The German SCS program entitles men and women aged 35 years and older to a visual skin examination every 2 years, regardless of their individual skin cancer risk. The 2-year participation rate was estimated at approximately 32%. Pooled estimates of annual percentage changes (APCs) in age-standardized melanoma mortality rates in German and non-German control regions were calculated using a random-effects model. Data include a mean of 79.1 million inhabitants in Germany and 164.8 million inhabitants in 9 neighboring countries. Between 2009 and 2022, age-standardized melanoma mortality rates decreased in each included region. In Germany, APCs ranged from -3.8% (95% CI, -5.5% to -2.2%) to -0.1% (95% CI, -1.7% to 1.5%). In the control regions, mortality rates decreased between -3.8% (95% CI, -4.9% to -2.7%) and -1.0% (95% CI, -1.9% to -0.2%) per year. Pooled APC estimates are -1.8% (95% CI, -2.3% to -1.4%) for Germany and -2.2% (95% CI, -2.8% to -1.6%) for the non-German control regions; the difference was not statistically significant (P = .42). The findings of this ecological study are in line with previous studies that failed to show a melanoma mortality benefit associated with the German SCS program. To enable a well-founded decision on the future of the program, the causes of its poor performance should be investigated.