By Siva Kumar
I was delighted to be offered the opportunity to attend the World Melanoma Congress in Brisbane this year. This was a conference attended by over 1,000 medical practitioners and stakeholders, all of whom were involved and interested in the same subject, namely improving outcomes for people with melanoma.
The meeting, which was held in the Brisbane Convention & Exhibition Centre spanned four days and covered a breadth of topics ranging from prevention, cancer cell biology all the way through the pathway onto treatment and aftercare. This event was attended by the world’s leading experts on the melanoma. There was also a healthy representation from the United Kingdom, including Howard Peach from Leeds, Marc Moncrieff from Norwich and Alistair Mackenzie Ross from London.
Key note speakers included Prof Georgina Long who gave an update and overview of the latest medical evidence for melanoma treatment in 2017. Dr Jerry Gershenwald talked through the new AJCC Melanoma Staging; a tool that is to be implemented by all units across the world from January 2018. Prof John Thompson from the Melanoma Institute of Australia talked about the evolving role of surgery, especially in Stage IV melanoma. And Dr Caroline Robert from the University Paris Sud discussed all the latest research in melanoma immunotherapy.
The headline topic was surely the emerging and evolving role of immunotherapy for the treatment of Stage III melanoma. Numerous trials that have been performed and are still ongoing which suggest that immunotherapy can be used successfully as the first line treatment for many patient with melanoma that has spread. In some instances it may replace the need for morbid surgery and this was a hotly debated topic at the sentinel node session.
The consensus was that Sentinel Node Biopsy has an even greater role to play going forwards in identifying patients at risk of disease progression as we now have the tools to potentially treat these patients at an earlier stage. The final results of the adjuvant immunotherapy studies are to be published in 2018 and all the data so far suggests there is improved survival when used in Stage III melanoma patients.
Prevention & detection
There was also a large focus on prevention and early detection. It is well known that early detection of melanoma means less morbid surgery and a higher potential for cure. Further to this, it is widely recommended that each person performs regular skin self-exams to look for new or suspicious spots, and seeing their GP immediately to evaluate anything changing, itching or bleeding on the skin.
Because unprotected exposure to UV light is the most preventable skin cancer risk factor, the advice to everyone is to stay away from indoor tanning beds and seek protection from the sun’s harmful rays by using shade, wearing protective clothing and a broad-spectrum, water-resistant sunscreen; SPF30 or higher.
This advice is one of the founding aims of the Melanoma Fund; the charity that I represented at the event.
The Australians have had a lot of success with their health campaigns. Their public health messages are directed by each state in Australia and it was clear that in Queensland, where melanoma rates are the highest, there has been a big emphasis on developing new and out of the box ideas to deliver sun protection messages.
Perhaps the thing that struck me the most was the role that social media will play in education, especially in the case of informing younger people, and the role that technology is being used in ever increasing ways to help screen skin lesions with much more accuracy than ever before.
Take for example a new Photoageing App for melanoma prevention developed by a dermatology team in Essen Germany. It is a fun tool to use and the author has taken this App to various schools as an educational tool to inform teenagers on the dangers of sun exposure and in particular sunbeds.
Artificial intelligence (AI)
Adrian Bowling from MoleMap gave an interesting lecture on artificial intelligence and its usage in screening the population for melanoma. He made a valid point stating that dermoscopy is time consuming and there are only a limited number of dermatologists. Each year MoleMap assesses 1 million lesions but finds just 250 melanomas.
Obviously, this is not an effective usage of human time and one solution would be to use computer assisted diagnosis with sophisticated algorithms that spot suspicious lesions that help direct dermatologists to perform a hands on clinical diagnosis.
The increasing use of confocal microscopy often in conjunction with dermoscopy is increasing the accuracy of detecting early and in situ melanoma. This has two effects; firstly, melanomas that are detected earlier using this technique receive treatment earlier with a better chance of cure. Also, it is possible to detect benign lesions more accurately, meaning fewer patients are undergoing unnecessary surgical excisional biopsy.
Dr Sebastien Debarbieux and his team in Lyon proved the worth of confocal dermoscopy in pigmented lesions of the nail matrix, an area that is difficult to clinically diagnose accurately without the need for a surgical biopsy.
In summary, I believe we can all learn, borrow and adapt many of these ideas to promote protection and prevention of melanoma here in the UK. This knowledge is something I will bring to the table in my work in the MASCU at Queen Victoria Hospital and in my role as medical ambassador for the Melanoma Fund.