Commentary: Start with the KISS principle

Introdution

The article by Jackson et al asks the question whether a self reported questionnaire can enable selective screening or primary prevention of melanoma to be more precisely targeted towards groups at risk and thereby enhanced. To answer these questions it is important to define the issues and to deal with aspects of primary prevention and secondary prevention (or selective screening) separately.

Primary prevention

Primary prevention strategies attempt to reduce or limit exposure to carcinogens so as to prevent or slow down cancer.1 The criteria for effective primary prevention consist of recognisable risk factors, modifiable risk factors, and a demonstrated need for a primary prevention campaign.

In the case of melanoma there are constitutional risk factors about which little can be done, such as skin type, response to sunlight, and the tendency to freckle and develop moles on exposure to sunlight. Exposure to sunlight, however, particularly in large episodic doses during childhood, is a behavioural component that is amenable to change. The success that the sun smart campaign in Australia has had in modifying the attitudes and behaviour of young Australians confirms this.2

Whether or not this change is worth while in the United Kingdom will depend on the …