In 2008, the routine skin cancer screening programme was implemented in Germany. Since then, its medical and economical effects are evaluated and critically discussed.The aim of this study was to compare costs of skin cancer patients diagnosed with vs. without preceding skin cancer screening.We conducted a retrospective observational study using claims data from a large German health insurance company for the period 2013 to 2016. We applied entropy balancing, difference-in-differences estimation and generalized linear models to compare costs of cancer patients with and without screening. We conducted sensitivity analyses to test for the robustness of results.In total, 12,790 skin cancer patients were included in the analyses, of whom 6,041 patients were diagnosed by skin cancer screening. Treatment costs were € 467 higher in patients without screening. Screening costs for all people insured by the health insurance company resulted in additional costs of € 1,339 to € 1,431 per skin cancer patient diagnosed by screening. Thus, total costs including costs for treatment and screening were € 872 to € 964 higher for patients diagnosed by skin cancer screening.Skin cancer screening has the potential to reduce treatment costs. However, the screening costs exceed these savings.