High-risk melanoma clinic in Sydney
Associate Professors Graham Mann and Scott Menzies both graduated with medical degrees from the University of Sydney, but then Graham branched out into medical oncology and Scott, dermatology. However, they found a common goal in the fight against Australia’s national disease: melanoma. Now, they are working together as part of a team of researchers leading a high-risk clinic for melanoma in Sydney.
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The high-risk clinic was created in February 2006 to follow patients who are at high risk for developing melanoma, using technologies to detect melanoma very early on the skin.
Total body digital photography and individual mole imaging is used to give the patient a complete digital record of their entire skin on CD which enables accurate follow-up of their skin.
There are specific criteria for patients to be referred to the high-risk clinic:
- People who have melanoma and dysplastic nevus syndrome (both multiple irregular and normal moles).
- People who have more than one melanoma.
- When there is a known mutation (the patient attended family cancer clinic, genetic counsellor and been clinically tested).
- People who come from a melanoma-prone family with four or more relatives who have had been diagnosed with melanoma.
“We’re trying to find out, from this clinic, what determines who is at risk of melanoma,” explains Graham. “We’re also questioning what makes melanoma different from each other. Two people can have the same melanoma and it will react differently in each of those people, potentially causing death in one and not the other; it may also spread in one person and not another. Obviously, it is very important that we find out why that is the case.”
Although they are also looking into the treatment of melanoma, Scott maintains that it is early detection that is the key for people who are at high risk of the disease. “The problem is that there is basically no effective treatment once melanoma has spread to other areas of the body,” he says. “That is why we set up this clinic: to catch signs of melanoma early so that patients have a greater chance of survival.”
“Melanoma is a significant cause of death in Australia. There is a lack of curative therapies, so we need to catch signs of melanoma early so that patients have a greater chance of survival.”
So far, they are achieving their goals, with more than 300 people currently enrolled in the clinic for surveillance. “We examine the participants every six months using a number of techniques to see if there is any change,” says Scott. “We are picking up new cases of melanoma within the clinic through the digital photography and therefore we can make sure it is treated promptly.”
“We also show the participants how to look at their own skin and compare it to the photos,” adds Graham. “This gives them the power to be able to pick up if there is a change that could be a melanoma.”
The clinic is also looking at the psychological impacts of being at high risk of melanoma to be able to increase the care and treatment of patients.
“Because this is a targeted study, we are able to take a more personalised approach to early detection and risk management,” says Graham. “There is not currently a program for screening in Australia, and indeed, there are doubts about how efficient that would be.
“By monitoring some of the highest risk patients in the world, we can start to understand which genes create melanoma, whether gene damage makes a difference and also what makes melanoma respond to treatment.
“By providing answers to these questions, we have the potential to find out which melanomas are likely to metastasise and therefore make treatment more effective.”
Even though there have been recent media campaigns by both the Commonwealth and NSW Governments to raise awareness of how to prevent skin cancer within the community, Scott and Graham believe there is more that we could do.
“The key is for people to know when they should see their doctor,” says Scott. “Unfortunately, most people don’t know what to look for, so it is left undetected in a large number of cases, until it is too late. We are particularly seeing a greater incidence in men over 50 years of age.
“What I would like to see is more money spent educating school children, so that every child knows what to look for. Then, future generations will have a greater chance of controlling skin cancer and reducing the threat of disease.”