Due to the high UV radiation and behavioral risks, an increase in the incidence of melanoma in the world has been observed. However, unfortunately in Brazil, for example, there is still a lot of underreporting of this condition. Therefore, according to this text, a model that can be followed is that of Australia, which even with a small number of dermatologists compared to Brazil, the incidence of melanoma is higher. This is because dermoscopy and screening are performed, but also not only by general dermatologists in review and follow-up appointments. Thus, melanomas are present in the Australian population with early diagnosis and cure, with low mortality. Thus, ideally, it would be necessary to apply this training to all general practitioners and physicians who are not specialists in dermatology, encouraging them to investigate how the patient, but with the possibility of a cure, is diagnosed early.

Sentinel lymph node biopsy provides very important prognostic information. However, it is an invasive procedure that may be associated with relevant morbidity. Thus, the development of an online tool that accurately reduces the unnecessary indication of this procedure is extremely relevant for both doctors and patients to minimize the associated costs and minor morbidity risks, while also providing the most accurate prognostic and staging information.

There is an urgent need for better training for doctors to deal with such a problem in Brazilian public health. It is unacceptable that, in a country of continental extension like Brazil, it does not have a policy to combat this skin disease. Taking only Rio Grande do Sul as an example, we have approximately one thousand and one hundred dermatologists, a specialty capable of dealing with melanoma in a population of approximately eleven million inhabitants. Australia, for example, the country with the highest global incidence of melanoma, has approximately 300 dermatologists to monitor the national territory, with about 26 thousand inhabitants, more than double the population of the southern Brazilian state. This is due to a policy of training general practitioners in diagnosing this disease that can be fatal. Unfortunately, it is still a distant reality for the tupiniquim nation.

Although skin cancer tends to increase, mortality has been decreasing and this is due to the population's awareness of the use of sunscreen, screening with the aim of obtaining early diagnoses and new therapeutic approaches. For this reason, physicians, not only dermatologists, but mainly primary care physicians, should prioritize the whole-body skin examination, which would increase diagnostic sensitivity and specificity. In Germany, the SCREEN project was established, a national program for the early detection of skin cancer, and after five years of its institution, a significant decrease in mortality from melanoma in the population was observed. And although there are already some therapeutic techniques, studies are still needed that can improve qualified treatment and a careful choice to avoid unnecessary interventions such as lymph node centinelle, which can lead to infection, lymphedema and neuropathic pain. With the Melanoma Institute Australia (MIA) nomogram, it allowed a better prediction of sentinel lymph node positivity, in this way the number of patients undergoing unnecessary sentinel lymph node biopsy was significantly reduced, contributing to a more qualified assistance for melanoma.

Although melanoma is a cancer of increasing incidence, related mortality has decreased thanks to education in sun protection, screening and early diagnosis; not mention the new therapeutic approaches. This means that the competence of physicians, dedication to careful anamnesis and new techniques are essential variables for a more assertive technical assistance.

Melanoma occupies the 5th place in cancer incidence in the USA. The worldwide incidence tends to increase, but mortality has been decreasing, which is due to greater education with sunscreen, early diagnostic screening and new therapeutic approaches. melanoma should be stimulated, as disease progression leads to molecular changes that make treatment more difficult and worsen prognosis. Tumor progression is characterized by aberrant proliferation, loss of apoptosis, metastatic spread, and induction of angiogenesis, which is mediated by via MAPK. A qualified treatment for melanoma should include better outcomes and reduction of unnecessary iatrogenic interventions. Sentinel lymph node positivity is an important prognostic factor, contributing to the decision regarding adjuvant treatment

Although the incidence of melanoma is increasing, its mortality worldwide has been decreasing, thanks to greater education with sunscreen, early diagnosis and new therapeutic approaches. A quality treatment for melanoma must include better outcomes and reduction of unnecessary medical interventions. Therefore, in January 2020, the MIA nomogram was published, anticipating sentinel lymph node positivity. By MIA, the risk is based on six parameters: age, tumor thickness, melanoma subtype, number of mitoses per mm², ulceration and lymphovascular invasion .The MIA was validated, and showed an AUC of 73.9%. After that, the number of patients undergoing sentinel lymph node biopsy was significantly reduced, thus contributing to a better care of patients with melanoma and a decrease in invasive medical procedures and unnecessary.

Nowadays, melanoma has become a common disease worldwide. However, while the incidence of this type of skin cancer is increasing, its mortality is reducing due to education in sun lotion and early diagnosis. As future physicians we should be encouraged to conscientize our patients and ourselves about the importance of early diagnosis of melanoma. For this aim, we continue investigating for more information and remain encouraging global training in dermoscopy as well as the performance of full-body skin examination.

It’s interesting to see how, with melanoma being such a prevalent cancer, science has manifested itself in a decrease in its mortality rates. We see, then, the importance - once again - of improving the education of physicians (to examine their patients more closely) and of the population (to understand what the risk factors are, preventive measures and when to seek help). Systematic screening for the disease also seems to be a promising measure, since early diagnosis would prevent the progression of the disease and its consequent molecular changes that would make it more refractory to treatment . Let's wait for the next few years and studies to see if its cost-effectiveness is worth it.

Melanoma screening is of utmost importance for early detection, timely treatment, and ongoing monitoring of these types of skin cancers. It plays a key role in reducing morbidity and mortality, as well as promoting awareness of prevention and self-care. I was already present in a discussion of the dermatology class that the professor made clear the importance of preparing doctors to avoid unnecessary iatrogenic interventions, since this can be extremely harmful to the patient. Therefore, the preparation of professionals should be an agenda raised in all screening centers for the disease.