Linos and colleagues provide important evidence that the increasing incidence of melanoma is not solely from increases in thin melanomas discovered by more intensive screening. This underscores the inadequacy of primary prevention to date, and the importance of early detection for reducing mortality in the near future. The US Preventive Services Task Force finds insufficient evidence to recommend for or against skin self-examination and clinician skin examination. Neither is commonly practiced now, but both are required for effective early detection. Evidence regarding benefits, harms, and costs of melanoma screening will help in securing widespread endorsement of these activities.