OBJECTIVES: Patients at very high risk of cutaneous melanoma make up 18% of the patient population diagnosed with melanoma in Australia. We aimed to estimate the five year healthcare budget impact of providing specialised surveillance using total body photography and digital monitoring of suspicious lesions for this high-risk population, from the perspective of the Australian health care system. Currently the cost for monitoring of suspicious lesions is largely borne by the patient, however in this study we analysed these services as health system costs. METHODS: A budget impact model was constructed using Microsoft Excel to assess the costs of specialised surveillance and potential savings. Data was utilised from a cost-effectiveness analysis and a micro-costing study conducted in a public hospital clinic where specialised surveillance was conducted, and Cancer Registry data to estimate the patient population and costs of surveillance from 2017-2021. RESULTS: If all eligible patients were monitored using specialised surveillance rather than the current service provided, the total cost savings to the Australian health care system in the first year would be $AU 2.4 million ($US 1.7 million), and in the fifth year $AU 13 million ($US 9 million). The cumulative cost savings over this period would be $AU 34 million ($US 23.2 million). If the introduction of the program was staggered from 60% coverage in year one to 90% coverage by year four, the cumulative cost for specialised surveillance over five years would be $117 million ($US 80 million), amounting to savings of $AU 28 million ($US 19 million). CONCLUSIONS: Specialised surveillance has the potential to lead to cost savings for the Australian health care system. Reimbursement through provision of Medicare Benefits Schedule rebates would alleviate out of pocket costs for patients. Follow-up should be conducted to investigate whether the current low rate of excisions is maintained.