Emeritus Professor of Surgery, University of Sydney
Melanoma is known as the Australian cancer. The papers in this edition of Cancer Forum cover many aspects of melanoma from prevention to the management of advanced disease. Leading Australian clinicians and researchers have contributed to this series of articles.
The situation for those unfortunate enough to develop melanoma has changed for the better over the last 30 years. From almost epidemic rises in incidence rates, these rates have now almost stabilised and the death rate, while not yet stable, has fallen dramatically. At the present time survival for melanoma exceeds 90%.
Melanoma screening is not recommended by authorities in Australia, yet routine skin examination is widely practised. Mark Elwood’s paper looks at the evidence and issues surrounding this controversial subject.
Susceptibility to melanoma is an important new area of genetic research in Australia. The melanoma genetics laboratory under the direction of Graham Mann has become a leader in this area. Mann’s paper reviews the current understanding of the role of genetic factors in causation of melanoma.
Early diagnosis of melanoma has been substantially improved by dermoscopy, a topic discussed in detail by Scott Menzies, while a new direction to identify the presence of malignant cells in lymph nodes and possibly in the skin by magnetic resonance spectroscopy is outlined by Jonathon Stretch.
The management of melanoma involves surgery, medical and radiation oncology. Surgery for melanoma, reviewed by John Thompson, has gone from radical and disfiguring wide excisions down to narrow excisions based on new understandings of genetic susceptibility, melanoma biology and behaviour. Thompson looks at sentinel node biopsy, the advent of which has seen elective radical nodal surgery all but disappear.
Richard Kefford and Graham Stevens discuss the management of advanced melanoma, which remains less than satisfactory despite many clinical trials involving chemotherapy, biochemotherapy and immunotherapy. Currently most patients who develop advanced melanoma are entered into controlled clinical trials seeking a better outcome than can be achieved at the present time.
Immunotherapy, reviewed by Peter Hersey, has evolved as a promising new approach to the prevention of recurrence and perhaps the treatment of advanced melanoma. Adjuvant immunotherapy is under intensive investigation but to date results have not justified the introduction of this technique as standard therapy. Many vaccine trials are currently in the accrual phase.
During my career as a surgical academic at the University of Sydney and in the Sydney Melanoma Unit I have been privileged to take part in major developments in melanoma management and medical education. My paper, in this edition of Cancer Forum, outlines my views of those developments in melanoma management, and my academic colleague Ann Sefton outlines the developments in medical education at the University of Sydney, which has undergone dramatic change over the last 30 years. From a traditional six-year preclinical to clinical program, the curriculum has gone firstly to a five-year program and then to the current four-year program. From a didactically presented teaching methodology, the four-year program concentrates on small-group learning and problem solving tutorials allowing the student to gain knowledge and skill by interacting with other students and with computer-based interactive learning programs
I hope this edition of Cancer Forum will be interesting and informative for our readers.