Australia has the world’s highest incidence of skin cancer.¹ Skin cancer incidence and mortality is higher in males than females.² Melanoma (melanocytic skin cancer) is the third-most common invasive cancer diagnosed in Australia. In 2021, an estimated 16,878 Australians were diagnosed with invasive melanoma and a further 27,585 were diagnosed with a melanoma in situ (stage 0; early form of melanoma).² Melanoma incidence is similar for males and females up to the age of approximately 45 years but by age 80 years the incidence is twice as high for males than for females. Melanoma incidence increases with age but is disproportionately high among young adults compared to other cancers, and is the most commonly diagnosed cancer for the age group 20–39 years.² Once a person has developed a melanoma, they are at approximately 5- to 10-times higher risk of developing another primary melanoma, although personal risk varies according to the presence of different risk factors.³ 

Keratinocyte cancers (non-melanocytic skin cancers), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are common in the Australian population. It is estimated that over two-thirds of Australians will develop a keratinocyte cancer in their lifetime, and many people develop multiple skin cancers.⁴ 

Skin cancer is highly preventable through sun protection strategies. 

It is estimated that skin cancer–related conditions account for approximately 3% of all health problems managed in Australian general practice (not including primary care skin cancer clinics), and this is higher in regional or remote areas and in areas associated with lower socioeconomic status.⁵ 

Identifying risk of melanoma 

Use one of these validated melanoma risk assessment tools to determine risk level:

• Risk prediction tools | Melanoma Institute Australia
• Melanoma risk predictor | QIMR Berghofer Medical Research Institute 

The following are considered at high risk of melanoma: 

• those with previous melanoma. 

The following are considered at very high risk of melanoma: 

• those with previous melanoma plus any of
  • multiple atypical naevi 
  • multiple primary melanomas 
  • family history of melanoma
• known carrier of high-risk variant in CDKN2A gene. 

Use the following keratinocyte cancer risk assessment tool to determine risk level:

• Keratinocyte cancer risk score | QIMR Berghofer Medical Research Institute 

Refer to the Resources section for further information on these tools.

Sun protection times are available from the Bureau of Meteorology. Apps for Apple and Android tablets and smartphones or desktops provide real-time electronic alerts on recommended sun protection times, current and maximum ultraviolet (UV) levels, and information on recommended exposure for vitamin D. They are adjustable to specific geographic locations around Australia and internationally, available at SunSmart Global UV. 

Most Australian adults will maintain adequate vitamin D levels from sun exposure during typical day-to-day outdoor activities. There is little evidence to suggest that sunscreen increases risk of vitamin D deficiency.¹⁴ 

Relevant validated risk tools (calculators) for the Australian population available to help individuals assess risk

• Risk prediction tools | Melanoma Institute Australia
• Melanoma risk predictor | QIMR Berghofer Medical Research Institute
• Keratinocyte risk score | QIMR Berghofer Medical Research Institute 

Each risk tool provides a valid assessment of personal risk, but they have been developed and presented differently depending on the population for whom they are intended (ie people with or without a previous melanoma) and because there is little evidence guiding optimal risk category classification and cut-points. The risk tools have been comprehensively developed but some rare risk factors may be missing, such as immunosuppression (eg among organ transplant recipients). 

Genetic risk assessment 

Individuals with or at risk of a mutation in the CDKN2A gene or at high risk for new primary melanoma 

In individuals with a strong family history of melanoma (ie three or more cases in first- or second-degree relatives) considered where predictive features are present, such as multiple primary melanoma, early age of onset, pancreatic cancer, or multiple other cancers, clinical genetic testing for CDKN2A or other high-risk mutations and genetic counselling should be undertaken.⁶ 

Cancer Institute NSW eviQ guidelines provide information on risk assessment and clinical genetic testing for CDKN2A.¹⁵

Aboriginal and Torres Strait Islander people are usually at lower risk of skin cancer, but their actual risk will depend on the presence of risk factors including the level of skin pigmentation. When Aboriginal and Torres Strait Islander people are diagnosed with skin cancer, they generally experience poorer outcomes. Thus, it is important that they are provided with education that raises awareness of the early signs of skin cancer, and are encouraged to be familiar with their skin and get any suspicious new or changing spots checked by a doctor. It is also important to note that the acral lentiginous subtype of melanoma, which accounts for approximately 1% of melanomas diagnosed in Australia, is the most frequently diagnosed melanoma in persons with darker skin colour, is not related to sun exposure, and often has a poor prognosis.¹⁶
 
For specific recommendations for Aboriginal and Torres Strait Islander people, please refer to the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

Immunosuppression is also a strong risk factor for skin cancer, and organ transplant recipients are at very high (very much above average) risk of keratinocyte cancers.⁷

Educational tools and resources for health professionals to provide messages about skin cancer prevention, vitamin D and the early detection and management of skin cancer:

Resources for health professionals | SunSmart
Sunscreen for skin cancer prevention, Handbook of non-drug interventions (HANDI) | RACGP