Frequent skin self-examination (SSE) and periodic professional total-body examination (TBSE) are considered by many dermatologists an almost mandatory part of “secondary prevention” of melanoma. This belief stems from the notion that wider public screening results in the detection of earlier and more treatable melanomas. However, the United States Preventative Services Task Force (USPSTF) has continued to withhold making a recommendation for or against SSE or TBSE, triggering a storm of controversy.

In this issue of The Melanoma Letter, Dr. Shawn Allen presents a thorough, balanced overview of this complicated and clinically important topic. While presenting the issues raised against widespread screening, Dr. Allen explains why it is so intuitively attractive for melanoma. He also summarizes recent studies supporting melanoma screening that were unfortunately not yet available or not considered when the USPSTF made its latest recommendations.

In a companion piece, Dr. Allen explores the integrally related concept of overdiagnosis. Acknowledging the growing recognition in both the scientific literature and the public media that overdiagnosis is a legitimate concern, he calls for tempering our approach to cancer screening in general and melanoma screening in particular. The very ease with which melanoma lends itself to early detection by simple visual inspection holds both the promise of effective screening and the risk of overdiagnosis.

One theory is that screening may result in “harvesting” biologically indolent melanomas, driving up the incidence rate without significantly affecting the death rate. However, although screening probably has little effect on early detection of rapidly growing tumors such as nodular melanomas, it may enhance early detection of slower-growing melanomas. These slower-growing melanomas are likely to continue growing and eventually metastasizing if left untreated, so the inevitable logical result of screening efforts has to be lives saved.

Lacking definitive randomized clinical trials of melanoma screening, we must balance its unproven lifesaving potential against the physical, emotional, and financial costs of labeling those with slow-growing tumors as having a deadly melanoma. The strategy so eloquently articulated in this issue for achieving this balancing act is to utilize all tools available to maximize early, definitive melanoma detection while simultaneously mitigating the impact of such a diagnosis on our patients.