The 50th edition of the Premio Paganini, held in 2004, the year in which Genoa was European Capital of Culture, was a significant milestone as it was the first edition to be held after the decision to hold the competition once every two years. The new Artistic Committee, chaired by the Mayor of Genoa, Giuseppe Pericu, is composed of representatives of the city's musical institutions (Carlo Felice Opera House Foundation, GOG "Giovine Orchestra Genovese" and the "Niccolò Paganini" State Conservatory).

The role of artistic director was assigned to Cesare Mazzonis, an internationally important figure in the world of music, who also acted as chairman of the competition jury. The decision not to award the first prize in 2004 derived from the desire to raise the standards and enhance the prestige of the competition. Various new developments were gradually introduced, starting from the pre-selection of competitors, the commission of a new piece written especially for the competition (Syncopations by Azio Corghi) and increasing the value of the first prize to the same level as other international competitions.