[Early detection of melanoma. Discussing a new approach].

Mortality by melanoma has not decreased, despite intensive medical screening, multiple campaigns based on ABCD, and a more efficacious surveillance of people at risk by dermatologists. We thus have to modify our strategy and to target the general population. Indeed, most melanomas do not develop in people identified as at risk, 2/3 of melanomas are self-detected by individuals, and melanoma responsible for mortality are often fast-growing ones, which give few opportunities to be detected early enough by chance by a doctor, although they can be by any aware individuals. Public campaigns can make everybody able to self-detection of melanoma, on condition that images of nevi and melanoma are used as educational support, and not artificial algorithms such as ABCD which lead to an overload medical system with irrelevant consultations. Self-surveillance and detection of nevus changes must be promoted by providing all at risk people with photographic references. By training general population and involving its responsibility, anybody who will feel that he has a suspicious lesion should have a direct access to the "diagnostic test", which is the dermatologist opinion, ie the "mammography" of the skin cancer. GPs and occupational doctors by the multiple opportunities to see people skin should go on their major role to detect lesions, which would not be self-detected.