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A world without melanoma

Tuesday 17 November 2020

University of Queensland Dermatology Research Centre - The next steps for a future without melanoma

If we are to eradicate melanoma as one of the world's most devastating cancers and stop it taking thousands of lives every year, the crucial element in that mission is research.

Over the last 10 years, supported by the PA Research Foundation (PARF), the University of Queensland's (UQ) Dermatology Research Centre (DRC) has been heavily involved in advancing imaging technologies, improving tele-dermatology and exploring genetic links in melanoma risk, all with one aim – a world without melanoma.

Early detection

We all know the sun safe message, but under the guidance of Professor H. Peter Soyer, the DRC is redefining early detection of melanoma with a two-pronged approach, centred on identifying those most at risk and using innovation and technology to monitor their skin on an ongoing basis.

The concept of precision prevention of melanoma involves two methods, the first being behavioural and the second being detection of melanomas and skin cancers.

"Our research is combining what's known as the phenotype and genotype. The phenotype is how we are looking, for example, if I see your blue eyes and red hair, I know that you are at higher risk for skin cancer," Prof Soyer said.

Professor H. Peter Soyer

"You are also at a higher risk if in addition you have many moles or a high degree of sun damage. These are things which we can very soon automatically measure with the VECTRA Whole Body 360 3D Imaging System."

"Then comes the genotype, the genes which basically make you. This also helps us characterize high-risk individuals."

The second phase of the DRC's work, referred to as innovative surveillance, involves the VECTRA Imaging System, which takes 92 photos of a patient in less than a second to help clinicians identify troublesome moles and lesions. Combined with cognitive computing with artificial intelligence, it will ultimately aid in making a faster diagnosis.

Identifying those most at risk

Genetics as a risk factor for melanoma is also a key area of research for the DRC with many Australians not aware of how much their genes can increase their risk. The team's work in this space is anchored around identifying specific gene mutations which point to a high melanoma risk.

"There are two relevant clinical settings for people to get melanoma. One is the classical Australian story of patients with severely sun damaged skin over decades. These are people over 50, when they get to 60-65, they have an unprecedented degree of sun damage," Prof Soyer said.

"These people get skin cancer, basal cell carcinomas and squamous cell carcinomas and their precursor lesions; but they also get chronically sun-damaged melanomas.

"The second group is people under 40 who get melanoma. There's not much difference in the incidence of people under 40 who get melanoma between Australians and Europeans. These are people who nearly always have a significant genetic background. They have fair skin and other risk factors, but they also often have many moles.

"For people under 40, melanoma has the highest cancer mortality in Australia. Here genetics plays a significant role. Now DRC Genetic Counsellor Dr. Aideen McInerney-Leo has the tools to look at these people through very sophisticated genetic analysis, then offer them and their families genetic testing and counselling about how to manage their melanoma risk."

The first steps to a world without melanoma

Supported by PARF, the DRC and their partners established the first version of the VECTRA Imaging System in Australia in 2017 at the PA Hospital campus.

This milestone was instrumental for the team receiving a $10m grant from the Australian Cancer Research Foundation to transform skin cancer diagnosis by rolling out 15 more VECTRA Imaging Systems in Queensland, New South Wales and Victoria, with Queensland sites including Queensland Health Hospitals at Mt Isa, Cairns, the Sunshine Coast and Townsville.

VECTRA Whole Body 360 3D Imaging System

This will be followed by a melanoma cohort study using data gained from volunteer participants scanned by the VECTRA Imaging Systems and the establishment of a national image depository for future research purposes.

Excitingly, the project could transform the way healthcare is delivered, especially in regional areas.

"The VECTRA Imaging System is absolutely fit for telehealth. At the end of the day it doesn't make any difference if you look at the images on a high-resolution monitor and your patient is in Mt Isa or Cairns or your patient is next to you in your office" Prof Soyer said.

"Reality is, and this is not just the case in dermatology, many specialists do not live and work in rural and remote Australia. With telehealth, there is an opportunity to address this.

"In Mt Isa, for example, there will be no dermatologists for years to come, we will need to do the reporting remotely with the GPs and the doctors there. And telehealth will certainly lead to a paradigm shift.

"We are at the beginning of a long but exciting new journey."