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Self-skin Examination for Skin Cancer Detection in High-risk Populations: A Diagnostic Accuracy Study and Implications for Cancer Education
   

Self-skin Examination for Skin Cancer Detection in High-risk Populations: A Diagnostic Accuracy Study and Implications for Cancer Education

Mike Climstein, Michael Stapelberg, Ian Miller, Nedeljka Rosic, Jeremy Hudson, Paul Coxon, Nathanial Milani, Chris Robinson, Guillermo De Castro-Maqueda Joe Walsh
Journal of cancer education, Vol.First online
29/08/2026
: https://doi.org/10.1007/s13187-026-02977-z
: 42665703
 

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Self-skin Examination for Skin Cancer Detection in High-risk Populations
Published (Version of record)

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Ultraviolet radiation exposure Squamous cell carcinoma Basal cell carcinoma Skin neoplasms Melanoma
Background/Purpose: Aquatic populations experience high cumulative ultraviolet radiation exposure and elevated skin cancer risk. Self-skin examination is widely promoted within cancer education strategies; however, its diagnostic accuracy in high-risk groups remains unclear. Method: Adults (≥ 18 years) participating in surfing or outdoor swimming (≥ 1 h/week) underwent full-body skin examination by an accredited skin cancer doctor. Prior to examination, participants identified any lesion(s) of concern, reflecting real-world self-detection. Suspicious lesions were biopsied or excised, with histopathology as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Among 191 participants (123 surfers, 68 swimmers), 50.8% were diagnosed with at least one skin cancer. Basal cell carcinoma was most common (n = 42), followed by melanoma (n = 26), SCC in situ (n = 17), and SCC (n = 3). Self-detection demonstrated modest sensitivity for BCC (69.0%) and melanoma (61.5%), with low specificity (~ 44-47%) and consistently low PPVs (< 30%). False-negative rates were substantial for BCC (31.0%), SCC in situ (41.2%), and melanoma (38.5%), indicating that many cancers were not self-recognized. Conclusion: Self-skin examination demonstrated limited diagnostic accuracy in high-risk aquatic populations. From a cancer education perspective, these findings suggest that self-examination may promote awareness but does not reliably support accurate lesion identification. Clinician-performed full-body skin examination remains essential for early detection. Cancer education for surfers and outdoor swimmers should therefore use self-examination to increase risk awareness and promote timely help-seeking, while emphasizing that the absence of a self-identified lesion does not exclude skin cancer.
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