Background
Melanoma screening remains controversial due to limited evidence on effectiveness, feasibility, and cost-effectiveness at the population level, particularly in low- and middle-income countries (LMICs). Structural barriers such as restricted access to dermatology services, long waiting times within public health systems, and geographic inequities disproportionately affect high-risk populations. Scalable implementation strategies that strengthen early detection while avoiding unnecessary procedures are urgently needed.
Objectives
To implement and evaluate an integrated, technology-enabled and community-based skin cancer screening model within the Brazilian Unified Health System (SUS), aiming to expand coverage, reduce diagnostic delays, promote equity, and support sustainable cancer prevention policies.
Methods
The Retrate Project was implemented by Barretos Cancer Hospital (Brazil) within the Brazilian Unified Health System (SUS) using an implementation research framework that integrates opportunistic, targeted, and population-based skin cancer screening strategies. The intervention combined multiple complementary components: (i) training of primary healthcare professionals to support early identification and referral; (ii) capacity-building of beauty and body care professionals (e.g., hairdressers and estheticians) to recognize suspicious skin lesions and promote timely healthcare-seeking; (iii) targeted outreach campaigns focused on rural and high-risk populations; (iv) population-based screening using a mobile application and an innovative self-service photo booth, which was iteratively optimized during implementation into a more compact, lightweight, and lower-cost kiosk to improve feasibility, mobility, and scalability in settings with limited access to dermatology services; (v) teledermatology-supported triage and referral, enabling remote specialist assessment and prioritization of in-person consultations; and (vi) structured annual follow-up with total body mapping for individuals classified as high risk. All screening, diagnostic, and follow-up activities were provided free of charge and fully integrated into routine public health care. Embedded health economic analyses were conducted to assess efficiency and cost-effectiveness. The study was approved by the institutional Research Ethics Committee.
Results
Between July 2023 and December 2025, 8,219 individuals were screened within a short implementation period. A total of 10,327 lesion images were assessed via teledermatology, resulting in 1,203 in-person consultations and 443 biopsies. Diagnoses included 239 basal cell carcinomas, 123 squamous cell carcinomas, 1 Merkel cell carcinoma, and 16 melanomas—exceeding the expected annual melanoma incidence for the region (6–9 cases). Of the 16 melanomas detected, 14 were diagnosed at an early stage. The proportion of biopsies yielding malignant diagnoses indicates appropriate triage rather than overdiagnosis. Additionally, 2,331 individuals were classified as high risk and enrolled in structured annual follow-up. Among melanoma cases, the mean time from lesion submission to completion of surgical treatment was 123 days, substantially shorter than the conventional 8–14 months commonly observed in the public health system.
Conclusions / Implications
This implementation study demonstrates that integrating digital health tools, teledermatology, self-service technologies, and community-based capacity-building within a public health system can rapidly expand screening coverage, reduce diagnostic delays, and improve equity without increasing unnecessary procedures. The Retrate Project offers a scalable and transferable model for cancer prevention in LMICs and provides actionable evidence to inform public health policy and implementation strategies in settings with limited access to specialized care.

Integrated implementation model of the Retrate Project within the Brazilian Unified Health System (SUS), combining population-based, opportunistic, and targeted skin cancer screening strategies, a structured patient journey from digital triage to diagnosi