Are All Screening Programmes Created Equal? The Case of Melanoma

graphic profile, but not undergoing educational campaigns [2] . One of the reasons to promote the early diagnosis of melanoma in the province of Trento was the consideration, in the words of the organizers in 1993, that ‘currently, the primary prevention of cutaneous melanoma is not possible’ since ‘risk factors have not been established and quantified with certitude’ [2] . After more than 20 years, the risk factors for melanoma are well established, and primary prevention is considered advisable, especially targeting children and young adults [3] . What about early diagnosis and screening? Screening is a strategy to identify an unrecognized disease in individuals, enabling earlier intervention and management in the hope to reduce mortality and suffering from a disease. Several types of screenings exist, from ‘mass screening’ involving a whole population to ‘selective screening’ conducted in subpopulations at higher risk (for example, people with more than a given number of melanocytic naevi or with a given skin phenotype) [4, 5] . Also different screening modalities, frequently combined, could be adopted. When dealing with skin cancer, for example, they may include promotion of self-examination, opportunistic screening by primary care physicians, dermatologist-based initiatives or referral to specialized pigmented lesion clinics. The use of teledermatology is also a new rising option. In this issue of Dermatology, Cristofolini et al. [1] present data on the incidence of cutaneous melanoma among 3,635 subjects who were found not affected by skin cancer in a screening programme conducted in the province of Trento, a northern Italian area, from January 2001 to December 2004, and who were followed up to December 2013 for assessing new lesions. Since no new case of melanoma was detected in a 2-year period after the first examination had taken place, and only 2 cases by the third year, the authors conclude that ‘in a selected population a screening program can be performed every 2–3 years’. There are some methodological problems that limit the validity of these conclusions. The screened population was younger than the general population in the area, and no age and gender standardization was made; moreover, the number of cases was too small to draw any firm conclusion. Educational campaigns for the early diagnosis of melanoma started in the province of Trento in the late 1970s and were then repeated periodically. The campaigns included several components: (1) training of dermatologists; (2) training of general practitioners; (3) education of the public for self-examination, through different media, and (4) free access to dermatologists for suspected lesions. In 1993, data were published showing that the province of Trento had lower mortality rates and a higher median age of death from melanoma compared to neighbouring Italian areas with a similar sociodemoReceived: August 13, 2015 Accepted: August 14, 2015 Published online: September 26, 2015