For decades, dermatology sat in the medical “basement”—a specialty many physicians saw as relatively low-stress and narrow in scope, with less prestige and lower reimbursement. Then something changed. Suddenly, we were told we faced a skin cancer “epidemic.” Annual full-body skin checks became a cultural norm. “Precancers” became a diagnosis people carried like a ticking time bomb. And a huge percentage of the public learned to fear the sun itself.
In this episode of the A Return to Healing podcast, Alan and I dissect how a specialty can reshape public perception, how screening can create the appearance of an epidemic, and why more biopsies and more “slicing” don’t automatically translate into fewer deaths.
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Download the Transcript (PDF)
Prefer to read? Save the full transcript for later – Download the episode transcript (PDF)
The “epidemic” problem: when more looking creates more disease
Here’s a hard truth that medicine struggles to say out loud:
When you screen more aggressively, you often find more abnormalities—even ones that may never harm anyone.
That doesn’t mean doctors are evil. It means screening is complicated. It can detect dangerous disease earlier, but it can also detect borderline findings, slow-growing lesions, and ambiguous “precancers” that might never have caused symptoms—especially when diagnostic thresholds expand and biopsy rates rise.
This isn’t unique to dermatology. We’ve seen versions of this dynamic across medicine: more testing can create more diagnoses, more procedures, and more “patients”—without always improving outcomes.
In fact, the U.S. Preventive Services Task Force (USPSTF) currently concludes there’s insufficient evidence to recommend for or against routine skin cancer screening (visual skin exam) in asymptomatic adults—an “I statement.” Again, that doesn’t mean “never see a dermatologist.” It means the evidence for routine population screening saving lives is not as clean or settled as the public messaging often implies.
Overdiagnosis is the part nobody puts on the billboard
Overdiagnosis is not a conspiracy term. It’s a real concept: diagnosing disease that would not have caused harm in a person’s lifetime.
There’s published discussion—especially around melanoma in situ—suggesting that increased detection can sometimes reflect overdiagnosis rather than a true surge in deadly disease.
And when overdiagnosis rises, something predictable happens:
- more biopsies
- more excisions
- more anxiety
- more follow-ups
- more “medical dependency”
…with unclear impact on mortality.
That’s the tension we unpack in this episode: activity looks like progress—but activity isn’t the same thing as benefit.
The sun conversation: common sense, not slogans
Now let’s talk about the sun, because this is where people get trapped between two extremes:
- “The sun is poison, avoid it at all costs,” versus
- “Sunscreen is poison, avoid it at all costs.”
Real life is less dramatic.
What we do know from evidence reviews and trials is that regular sunscreen use can reduce risk of melanoma and squamous cell carcinoma.
So I’m not going to tell you “sunscreen causes cancer” or that sun protection is a scam. That claim doesn’t match the better quality evidence we have.
“Precancers” and the psychology of fear-based medicine
One of the most powerful tools in marketing is fear—especially fear paired with an easy solution. If you tell people:
- “This is an epidemic,” and
- “You can prevent death with routine screening,” and
- “We can remove precancers before they turn into cancer,”
…you’ve built a self-reinforcing system: the more you screen, the more you find; the more you find, the scarier it feels; the scarier it feels, the more people comply.
This is how medicine drifts from care into industry.
What I will tell you is this:
- People deserve honest conversations about absolute risk, not panic messaging.
- Skin cancer risk varies dramatically by skin type, sun exposure history, geography, immune status, and family history.
- Sunscreen isn’t the only tool: shade, clothing, timing, and avoiding burns matter too.
- And if a health message makes you terrified of leaving your house, it’s probably been distorted.
If you’re high-risk (prior skin cancer, lots of blistering burns, immunosuppression, strong family history), you should not treat this blog as permission to ignore your skin. Use it as motivation to demand clarity and evidence from your clinicians—because that’s what you deserve.
What “protect yourself” actually means
Here’s a more grounded approach than slogans:
1) Know your personal risk: If you’re fair-skinned, burn easily, have lots of atypical moles, a personal/family history of melanoma, or are immunosuppressed, your risk profile is different—and your screening decisions should reflect that. The USPSTF explicitly notes higher-risk groups exist even while issuing an I statement for the general population. (USPSTF)
2) Avoid burns, not daylight: Chronic burning is a problem. Controlled exposure and practical sun protection are not the same thing as “fear the sun.”
3) Demand shared decision-making: If someone says “you need this every year” without discussing your risk factors, the evidence, and tradeoffs (false positives, overdiagnosis, unnecessary procedures), ask better questions.
4) Watch incentives: When fear-based messaging and high-volume procedures become normal, it’s reasonable to ask: who benefits? Medicine should always survive scrutiny.
How You Can Return to Healing
If this episode made you uncomfortable, good. Discomfort is often the beginning of clarity.
Watch the full episode and check out our book, then share this with someone who’s been told they’re a walking skin cancer diagnosis because of a single biopsy or a scary-sounding “precancer.” The goal isn’t to ignore real disease—it’s to stop confusing more medicine with better medicine.
→ Watch the episode on YouTube
→ Download the transcript (PDF)
→ Explore more episodes of A Return to Healing
Skin Cancer Screening Myths FAQ
Is there really a “skin cancer epidemic”?
Diagnosis rates can rise because screening and biopsy increase. That can reflect earlier detection—and it can also reflect overdiagnosis. The key question is whether mortality and serious disease outcomes improve in a meaningful way. (PMC)
Should I get an annual full-body skin exam?
For the general asymptomatic adult population, the USPSTF says evidence is insufficient to recommend for or against routine screening. High-risk patients may benefit from individualized screening decisions. Talk with a clinician who will actually weigh your specific risk. (USPSTF)
Does sunscreen prevent skin cancer?
Evidence reviews and trials support that regular sunscreen use reduces risk of melanoma and squamous cell carcinoma. Sunscreen is one tool among others (clothing, shade, timing, avoiding burns). (PMC)
Is it true that more screening always saves more lives?
Not always. Screening can help—but it can also increase false positives and overdiagnosis. In skin cancer screening, the evidence for mortality benefit from routine clinician visual exams is not definitive, which is why major guideline bodies remain cautious. (JAMA Network)
What should I do if I’ve been told I have “precancer”?
Ask what that means in plain language. What is the absolute risk? What are the options (watchful waiting vs removal)? What are the downsides? A good clinician won’t shame you for wanting clarity.
What are warning signs I should not ignore?
A new or changing lesion, bleeding, a spot that doesn’t heal, or a mole that changes per ABCDE characteristics deserves evaluation. Don’t use skepticism about screening as a reason to ignore symptoms. (USPSTF)
Reviewer’s note (Dr. Roth)
Dr. Alan Roth reviewed this post for medical clarity and to ensure we separate reasonable criticism of incentives and overdiagnosis from blanket claims that could lead patients to avoid needed care. The goal is discernment—not neglect. If you’re at higher risk or you have a concerning lesion, please seek an in-person evaluation with your physician.
