[Epidemiology and prevention of melanoma]

Melanoma incidence and mortality are still increasing, but new leveling-off and even decreasing trends are detected in young women generations in a few countries, where intensive prevention and screening campaigns have been conducted. Sun avoidance remains the basis of prevention, but is facing hard societal resistances. Sunscreens have a more and more theoretical protective profile, but in the real life, their ability to prevent skin cancers is quite uncertain. Some pieces of the melanoma genetic puzzle have been identified, but are not yet useful for the practical identification of patients at high risk for melanoma. Early detection is still the key for improving melanoma mortality. The most useful signs for melanoma detection are the impression of overall irregularity as compared to common nevi, the "ugly duckling sign" and a recent change. However, a subgroup of biologically aggressive melanoma will probably remain out of reach of early detection, due to their very rapid growth. In order to promote self-detection in the general population, a cognitive strategy using photographs is probably more efficacious than teaching the classical "ABCD" algorithm.