Table 1.

Screening and behavioral studies evaluating the impact of early melanoma detection in tumor thickness and mortality rates

Study	Study population: type/size	End-points	Findings	Support secondary prevention
Aitken JF, et al 2006, 2002 (59–60).	Community-based: Queensland, Australia. 44 eligible Queensland communities (aggregate population of 560,000 adults aged 30 or more) randomized into intervention or control groups to receive, a community-based melanoma screening program for 3 years vs. usual medical care.	Designed to detect a 20 % reduction in mortality from melanoma during the proposed 15 year intervention period	Due to the associated cost the clinical trial could not be completed. However, on the communities where the program was implemented overall thinner melanomas were identified in comparison with neighboring communities without screening intervention.	Yes
Schneider et al 2008 [9].	Community-based: Lawrence Livermore National Laboratory (LLNL). California, USA. Population ranged between 8,056–9,217 over 12.5 years (1984–1996) Screening program involving melanoma education, self-examination, and opportunity for physician based skin screening particularly targeting high-risk individuals. The study was divided in the early awareness period (1/1976-6/1984) and the education and screening program phase (starting 7/1984–12/1996).	Impact in thickness of diagnosed melanomas and mortality rates (1984–1996)	Resulted in a reduction in crude incidence of thicker melanomas (from 22 to 4.6/100,000 person-years) No eligible melanoma deaths occurred among LLNL employees during the screening period, whereas the expected number of deaths was 3.39.	Yes
Swetter S et al 2011 [56•]	Community-based survey study: California and Michigan, USA. 566 adults with invasive melanoma completed questionnaires within 3 months of diagnosis on demographics, health care access, skin self-examination (SSE), and physician skin examination (PSE) practices in the year before diagnosis	To identify differences in pre-diagnosis behavioral and medical care factors associated with thinner versus thicker melanoma	Patients who used a melanoma picture aid and performed routine SSE were more likely to have thinner tumors than those who did not (OR 2.66). Full-body PSE was associated with thinner tumors (OR, 2.51), largely driven by the effect of PSE in men aged >60 years (OR 4.09).	Yes
Katalinic A et al 2012. (65)	Population-based: Schleswig- Holstein, Germany. 360,288 individuals aged >20 years were screened by means of a whole-body examination. Between 7/2003–6/2004 Control: Reported melanomas in adjacent regions without screening program.	Impact in mortality rates through 2009	Melanoma mortality declined by 47 % per 100,000 men and by 49%per 100,000 women by 2008/2009. The annual percentage change in the most recent 10-year period (2000–2009) was 7.5 % for men and 7.1 % for women.	Yes