The United States is now faced with a mounting public health problem of high and increasing incidence and mortality rates for melanoma, particularly among men who are middle-aged or older.1,2 Melanoma is a serious and often fatal form of skin cancer, even though most melanomas are readily visible when they are still thin and nearly always curable by surgical excision.3 Limited health resources are dedicated to preventing or promoting early detection of this cancer. One problem is that evidence for the value of melanoma screening is considered insufficient.4 With the recent cessation (owing to lack of governmental funding) of the only population-based, randomized screening trial (Mark Elwood, MB, e-mail communication, December 19, 2005), which was being conducted in Queensland, Australia, an early detection trial may never be funded. Thus, there may never be the kind of evidence that some require to conclude that screening effectively reduces melanoma mortality. Nevertheless, disturbingly low screening rates in the presence of increasing mortality prompts a call for a new and far-reaching approach for a national melanoma prevention and early detection program.
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