At what age do you recommend annual skin exams in a patient without a personal or family history of skin cancer?

I don't have a specific age but rather it depends on the risk factors:

• Male, fair skin, and older age are risk factors, certain occupations
• Evidence of actinic damage
• Immunosuppression, especially organ transplants
• Multiple nevi > 50
• History of dysplastic nevi
• Childhood radiation exposure
• Chronic lymphocytic leukemia

I agree. My recommendation regarding when to start annual exams really depends upon the risk factors, as above, and the findings on that initial total body skin exam. A history of significant sun exposure/tanning beds and clinical evidence of significant sun exposure could decrease my threshold to lower than 50.