Euromelanoma is a skin cancer prevention program. This Europe-wide initiative was set up in Belgium in 1999 to disseminate information about the need to promptly diagnose and treat skin cancer and to raise public awareness about the importance of taking care of our skin to prevent the development of malignant growths.1,2 The first Euromelanoma campaign in Spain was launched in 2000 by the Spanish Academy of Dermatology and Venereology (AEDV).

Since then, the campaigns designed to further the goals of Euromelanoma in Spain have included skin screening clinics by appointment, informative outreach initiatives, and in-person training sessions targeting groups, such as sports clubs, schools, and health sector professionals.1,3 The campaign has generally been promoted in a variety of ways, as follows: the distribution of print materials, brochures, and posters; the production of specific educational videos; photo exhibitions; and a presence in the traditional media, primarily the print media, radio, and television.3,4

In March 2020, during the COVID-19 pandemic, responding to the directives of the European campaign, the Euromelanoma team at the Fundación Piel Sana-AEDV had to rethink their campaign given the impossibility of organizing mass in-person skin screening clinics or the usual training sessions. In these special circumstances, a different approach was needed to raise awareness about prevention in general and in particular the dangerous effects of exposure to ultraviolet radiation and the need for early diagnosis.3 For this reason, the team launched a new initiative under the banner “Cuentos Lunares: poems and flash fiction that save lives”.

“Cuentos Lunares”# was an online literary competition organized using a website created specifically for the initiative supported by a social media campaign to spread the word. This was a collaborative and cross-cutting online project involving a number of different channels and media.

The website (www.cuentoslunares.es) was used for a variety of purposes: to provide a channel through which the public could take part in the competition (participation section); to provide reliable information on skin cancer and healthy habits (a section on skin protection); and a section designed to raise awareness about the Euromelanoma campaign.

The primary goal of the literary competition was to raise the visibility of Euromelanoma and to disseminate the prevention messages. A secondary aim was to generate creative content on the subject of the skin in the form of poems and flash fiction. Through micro-influencers and using social networks (Instagram, Facebook and Twitter), the team invited members of the public, dermatologists, and other collaborators to write a poem or a micro-story using a photograph as inspiration and limiting themselves to a single topic: the observation of moles or beauty spots (lunares in Spanish). The Instagram profile @cuentoslunares was used as a repository for all the entries received and as a channel for communicating with collaborators and followers. On Twitter, the contest was launched by the well-known and highly regarded writer J.J. Muñoz Rengel, a literary influencer. Packs were created for dermatologists, sponsors and collaborating brands containing graphic information and content designed to help them to support the campaign by promoting it on their profiles and social networks, thereby exponentially amplifying the invitation to participate in the contest as well as the primary and secondary prevention messages. A jury made up of writers and dermatologists (Aurora Guerra, Margarita Arroyo, Xavier Sierra, J.J. Muñoz Rengel, and Sergio del Molino) selected the best entries from all those received and these were then published in book form.

In all, 1800 entries were received through the different channels. The jury selected the fifty best submissions, which were compiled in a book entitled Cuentos Lunares, which is currently on the market and available for purchase on the Fundación Piel Sana website.5 The book also contains key messages about primary and secondary prevention of skin cancer. Information tagged with the campaign hashtags (#CuentosLunares and #Euromelanoma2020) has been published 2500 times, generating over 1200 conversations about the project. In general, information on the “Cuentos Lunares” initiative was seen at least once by 4.2 million people and appeared 7.8 million times on users’ screens.

One of the limitations of this campaign was that 75% of the participants were aged between 25 and 44 years, 20% between 45 and 54 years, and only 5% between 55 and 64 years.

In our opinion the Euromelanoma campaign in 2020 was a success; the novel format favored the active involvement of the audience; and participation, including that of celebrities, was much higher than in previous campaigns. All of this was achieved by means of a literary project unprecedented in awareness campaigns in Spain.

The health crisis caused by the COVID-19 pandemic has changed the practice of dermatology. It is unclear how long these changes will last, but they have affected the way patients access and interact with their physicians and have led to a downturn in medical and surgical activity in general. They may also have had a negative impact on morbidity and mortality associated with melanoma and on the costs of melanoma care.6 To explore this hypothesis, Ricci et al.7 conducted a cross-sectional study of the data on all consecutive cases of primary malignant melanomas recorded during three phases of the pandemic in the disease register of the Istituto Dermopatico dell'Immacolata è Instituto di Ricovero e Cura a Carattere (IDI-IRCCS), a referral hospital for dermatology in Rome, Italy: Phase 1, pre-lockdown, from 1 January 1 to 9 March, 2020; Phase 2, lockdown, from 10 March to 3 May, 2020; Phase 3, post-lockdown, from 4 May to 6 June, 2020. During the 158-day study, 237 malignant melanomas were diagnosed. Mean Breslow thickness was 0.88 mm (95% CI, 0.50-1.26) in Phase 1 rising to 1.96 mm (95% CI, 1.16-2.76) in Phase 3 (post-lockdown). While more research is needed to clarify whether or not this is an isolated phenomenon, the results of that study support the hypothesis that the structural changes caused by COVID-19 have delayed the diagnosis and treatment of malignant melanomas. In this situation, it is vital to maximize efforts to promote self-examination and education about warning signs.6 The usefulness of awareness campaigns and the results achieved in terms of educating the population about skin cancer risk factors and how to detect suspicious lesions had already been documented prior to the COVID-19 pandemic.8 But how can we achieve the goals of these campaigns safely and effectively in the new scenario? Villani et al.9 have suggested that dermatologists and public health organizations should provide practical and effective solutions for creating a different campaign model that can ensure safe conditions for patients and professionals without losing sight of the objectives of prevention campaigns. They propose that the new model for disseminating messages should include websites, social networks, mobile phone apps in addition to the traditional media (print press, TV, and radio).8 There is also considerable potential for using artificial intelligence in the field of skin cancer, and the possible uses of such technology go far beyond the dissemination of content. For instance, mobile phone apps can be used to collect live data and monitor ultraviolet radiation exposure10 or can help individuals to check their own skin.11 Euromelanoma Spain has been very active throughout the pandemic, promoting the use of digital tools to support self-exams during the lockdown (www.ederma.es)11 and, when lockdown restrictions were relaxed, disseminating warning messages via press, radio and television channels about the risk of sun exposure. The initiative also made available the phone app UV-DERMA: Photoprotection on your Smartphone.

These new outreach methods have many advantages. They offer a means to reach a significant percentage of the population by way of viral messages and they make it possible to update information rapidly10 and to adapt messages to target different patient and professional profiles at a lower cost. These new channels also allow the target audience to take an active part in the project. One disadvantage, however, is that these new channels have a greater impact on younger segments of the population, who tend to make more use of digital tools10 and, conversely, less impact on the middle-aged and older sections of the population.

Euromelanoma is already a well-established campaign with clear strengths; it is an altruistic network of European dermatologists with a centralized and standardized database working with a collaborative spirit that encourages participants to share logistics, materials, experiences, information and training activities.1–4 This campaign raises awareness in the general population and also raises the visibility and prestige of our specialty. In 2021, the campaign goals have not changed, but future success will depend on the ability to meet new challenges, such as making sure that the messages reach the population and especially those with risk factors, keeping the scientific community and the media motivated, ensuring that the necessary investment is made, and resolving the conflicts that threaten the acceptance of sun protection habits.8

Euromelanoma Spain succeeded in adapting quickly to this new scenario, creating an original campaign based on modern communication tools and an ingenious play on words in Spanish to ensure a communicative edge. This combination, together with the fact that the physical perception of touching skin and descriptions of skin have been a source of inspiration for artists and writers for centuries, resulted in participation levels exceeding all expectations.

In closing, we must highlight the work of the Fundación Piel Sana and all the dermatologists who each year contribute, in very different ways, to the success of Euromelanoma in Spain. None of this would have been possible without the contributions of collaborators, sponsors, and the media that supported and publicized the project.