Dad had a melanoma removed last year and I have more moles than I can count. Is a yearly skin check worth paying for or is it another add-on that just finds things?

My dad, 66, had a melanoma taken off his back last autumn. Caught early, thin, wide excision, no further treatment, and he's fine, but it has rearranged how I think about my own skin, which is fair on both sides of the family and covered in moles. I stopped counting at 60 on my arms and torso alone. I burned every summer as a kid because it was the nineties and nobody cared.

The clinic that did my checkup this year sells a "full skin cancer screen" as an add-on. Forty minutes, a dermatologist, some sort of camera, photos of everything, repeat annually. Not cheap. And this board has more or less trained me to distrust any add-on with the word "full" in it, so I'm torn. Half of me thinks this is the one add-on where my risk is real and it's stupid to skip it. Half of me thinks I'm about to buy a subscription to being biopsied.

So, is a yearly skin check worth it for someone like me? Does the family history change things or does everyone get told to have one? Is the photo thing (mole mapping?) actually useful or is it the upsell? And what happens in practice when they find one they don't like the look of?

I'm the resident cautionary tale about buying scans, so you'd expect me to say no. I'm going to say yes, and the reason is the difference between this and the full-body MRI that cost me five months of follow-up: your risk here is real and specific, and the "finding" when they find one is a mole they can take off in fifteen minutes, not a shadow on a kidney nobody can explain.

I have a lot of moles too, no family history though, and I've had a check every couple of years since my forties. Twice they've cut something out. Both benign, both left a scar the size of a fingernail, both worth the ten days of waiting for the lab in my view. It's the least frightening version of "they found something" I've been through.

Different data point. I'm not in your risk group (dark hair, tan rather than burn, maybe fifteen moles) and I took the skin add-on as part of my big package because it was included. Result: twenty minutes, nothing found, a set of photos I've never looked at again. For me it was the definition of an add-on that produced paperwork. For you with sixty-plus moles and a dad who's had one I'd guess it's a different calculation, but I'd want someone who actually knows to say so rather than me.

Nathan, I'll give you the short version first and the long version after: for your particular combination, a regular examination by someone who does them all day is one of the few add-ons on the whole menu where the arithmetic is on your side. For dgb it was paperwork. For you it is not.

The reason the two of you get different answers is that this is one of the screens where the evidence bodies specifically have NOT said "everyone, every year". When the U.S. Preventive Services Task Force looked again in 2023 they concluded there is not enough evidence to say whether checking symptom-free adults across the board does more good than harm, and that is why nobody sends the whole population an invitation at 50 the way they do for bowel screening. What the same evidence is clear about is who carries the risk, and you have just described most of the list: a high mole count (more than about 50 is the number that gets used), skin that burns rather than tans, blistering sunburn in childhood, and a first-degree relative with melanoma. Any one of those is worth mentioning to a clinician. You have four. That is the group dermatologists commonly see on a schedule, and it is the group where the annual check stops being an upsell.

On mole mapping. Total-body photography is genuinely useful for exactly one reason: with sixty moles nobody, including a dermatologist, can remember what each one looked like last year, and change is the thing that matters most. The photos turn "does this look wrong" into "is this new or different", which is a much easier question. For dgb, with fifteen moles, they are just photos. For you they're the point. What I'd check before paying is that the examination itself is done with a dermatoscope (the little polarised magnifier), because that's what improves accuracy, and that the same service will hold the images and compare them next year rather than starting from scratch.

On what happens when they find one. Usually it comes off under local anaesthetic and goes to a laboratory, and you wait a week or two for a pathologist, and most of the time it is benign, which is the expected result of a careful examiner and not a sign the check was pointless. Fi's two scars are what that looks like in practice.

I wrote up the whole question this month, including the uncomfortable bit about overdiagnosis of very thin melanomas, in the guide to skin cancer screening and mole checks. The one thing I'd add from my own history: the mole I "kept an eye on" for ten years after my blood pressure scare turned out to be nothing, but keeping an eye on it had meant never actually looking. Between checks, look. Once a month, whole skin, and the mole that doesn't match the others is the one to show someone, whatever it scores on the ABCDE list. And if anything changes before the next appointment, that's not a screening question any more, that's an appointment now.

I'm not a clinician, so how often you need seeing and by whom is your dermatologist's call, and they may well say yearly is more than you need or less. Your dad's history is worth taking with you in writing, because the type and thickness of his melanoma is part of your risk picture too.

Marisol Quintero said:

the mole that doesn't match the others is the one to show someone

This is the bit I'd underline. My wife spotted mine, a brownish one on my calf that was nothing like the rest, and I'd have walked past it forever because it was small and round and failed every letter of the checklist. It was fine in the end, but the dermatologist said "different from your others" was exactly the right reason to come in.

Booked it. Not the clinic's add-on in the end: my GP referred me to a dermatology service that does the same thing because of dad's history, so it's on a proper schedule with the images kept, which is what Marisol said to check for. First appointment is in November.

Also went through my back with my partner and a phone torch on Sunday, which was a first, and found nothing that worried either of us except how many there are. Will update once I've been.