Victorian Melanoma Service

Melbourne, Australia

Victorian Melanoma Service

Melbourne, Australia
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DeFazio J.L.,Sloan Kettering Cancer Center | Marghoob A.A.,Sloan Kettering Cancer Center | Pan Y.,Victorian Melanoma Service | Dusza S.W.,Sloan Kettering Cancer Center | Halpern A.,Sloan Kettering Cancer Center
Archives of Dermatology | Year: 2010

Objective: To assess current practices and recommendations of US physicians regarding depth of excision for melanomas of varying histologic thicknesses. Design: A 2-page, 13-question survey of depth of excision practices for the treatment of melanoma was developed and distributed. Setting: Both private and academic settings. Participants: A total of 1184 US physicians (1000 dermatologists and 184 melanoma specialists) were sent the survey. The 184 melanoma specialists included dermatologists, oncologists, and surgeons working in pigmented lesion clinics. Main Outcome Measures: Depth of excision practices reported for melanomas of varying histologic thicknesses and comparison of treating physician groups. Results were tabulated, and descriptive frequencies were used to describe demographics and survey responses. Results: The final study analysis included 498 completed surveys. The overall response rate was 45% (498 of 1097 [1184 total respondents - 87 ineligibles]). The response rate for the specialists was 63% (115 of 183 [184 total respondents - 1 ineligible]), and for nonspecialist dermatologists it was 43% (383 of 892 [1000 total respondents - 108 ineligibles]). Specialists were more likely to practice in an urban setting than were nonspecialist dermatologists (78% vs 46%) (P < .001). Fifty-eight percent of nonspecialist dermatologists reported more than 400 patient visits per month compared with only 16% of specialists (P < .001). While specialists reported fewer patient visits per month, 51% reported diagnosing over 20 invasive melanomas in the previous year compared with 11% of nonspecialist dermatologists. There was no significant difference in excision depth reported among the specialties for melanoma in situ (P = .15). For invasive melanoma, significant differences were observed among treating groups, with the greatest incongruence reported for thin invasive melanoma (< 0.50 mm, P = .02; 0.50-0.75 mm, P < .001; and 0.76-1.00 mm, P < .001). Specialist nondermatologists consistently reported excising more deeply than specialist dermatologists and nonspecialist dermatologists. More specialist nondermatologists report excising to the fascia for thin invasive melanoma than do both specialist and nonspecialist dermatologists. For thicker melanomas (> 1.00 mm), differences in excision depths among treating physician groups decreased: most physicians in each group reported excising to the fascia. Conclusions: There is considerable variation among physician groups with regard to depth of excision practices for the treatment of melanoma. Given the current lack of clinical data available, studies assessing depth of excision and patient outcomes are needed to better define our surgical management of melanoma. ©2010 American Medical Association. All rights reserved.


Pan Y.,Victorian Melanoma Service | Haydon A.M.,Victorian Melanoma Service | McLean C.A.,Victorian Melanoma Service | McDonald P.B.B.,Alfred | Kelly J.W.,Victorian Melanoma Service
Australasian Journal of Dermatology | Year: 2015

Background/Objective Information on the prognosis for patients with regional cutaneous melanoma metastases has been sparse and difficult to establish. In 2009 the American Joint Committee on Cancer (AJCC) melanoma staging has for the first time provided survival rates for patients who manifest intralymphatic metastases. We sought to validate the new staging system in this contemporary, prospectively collected cohort of patients following the development of cutaneous metastases as the first evidence of metastatic disease and explored the factors that influenced their prognosis. Methods The Victorian Melanoma Service database was searched to identify all patients with cutaneous melanoma metastases. Patients who were found to have lymph node or visceral metastases at the time they were diagnosed with cutaneous metastatic disease were excluded. Survival curves were generated and univariate and multivariate assessments of prognostic factors associated with survival were performed. Results In total, 72 patients presented with cutaneous metastases as the first evidence of metastatic disease. The median melanoma-specific survival of patients with only regional cutaneous metastases (n = 56) was 5.07 years and their 5-year survival rate was 52%. Distant cutaneous metastases and thickness of the primary melanoma were found to be significant negative predictors of survival. Conclusion We were able to validate the new AJCC melanoma staging system survival for patients with cutaneous metastatic disease. Patients presenting with regional cutaneous metastases have a much better prognosis than those with distant cutaneous metastases. © 2015 The Australasian College of Dermatologists.


Meani R.E.,Victorian Melanoma Service | Lim S.-W.,Victorian Melanoma Service | Chang A.L.S.,Stanford University | Kelly J.W.,Victorian Melanoma Service
Australasian Journal of Dermatology | Year: 2014

Vismodegib (GDC-0449, Genentech, USA), a small molecule inhibitor of the Hedgehog signalling pathway, has potent anti-tumour activity in advanced basal cell carcinoma (BCC). We report a case of a 67-year-old Australian man with metastatic BCC including pulmonary disease with malignant effusion who showed a dramatic complete response to vismodegib but subsequently experienced a recurrence of pulmonary disease, indicative of chemoresistance to vismodegib. This case is the first to illustrate chemoresistance in a patient with metastatic BCC, and demonstrates the need for closely monitoring metastatic BCC patients even after an apparently complete response. © 2014 The Australasian College of Dermatologists.


Wong C.C.,Skin and Cancer Foundation Inc | Liu W.,Victorian Melanoma Service | Gies P.,Australian Radiation Protection and Nuclear Safety Agency | Nixon R.,Skin and Cancer Foundation Inc
Australasian Journal of Dermatology | Year: 2015

Background Australia has the highest incidence of skin cancer in the world, a preventable disease caused primarily by exposure to ultraviolet radiation (UVR) in sunlight. Health promotion strategies play a significant role in sun protection. Objectives To assess the understanding of a population sample as to the time of year that the sun was 'at its most burning' in Melbourne, Australia. Methods A cross-sectional study was performed using questionnaires completed at corporate skin checks, conducted on 668 participants during 2011 to 2013. Results Only a minority (n = 82, 12%) gave the correct theoretical answer; the summer solstice or 21-22 December, while another 38% (n = 254) correctly named December and January as the times when the UVR is actually highest. In all, 18% (n = 122) said February was the month when the temperature is hottest and 170 (25%) either mentioned the period May-August when UVR is negligible in Melbourne or had no idea, including saying 'all year round'. There was no significant difference in this knowledge between different age groups. Conclusion One-quarter of participants did not understand that sunburn was related to high levels of UVR, which occur in summer. Almost one-fifth associated the heat of February with the highest UVR. Understanding these concepts is important for Australians residing in cooler parts of southern Australia, as UVR levels may be high and yet the temperature may be relatively cool. There needs to be more emphasis on UVR in sun awareness campaigns to prompt sun-protective behaviour. © 2014 The Australasian College of Dermatologists.


PubMed | Victorian Melanoma Service
Type: Case Reports | Journal: The Australasian journal of dermatology | Year: 2014

Vismodegib (GDC-0449, Genentech, USA), a small molecule inhibitor of the Hedgehog signalling pathway, has potent anti-tumour activity in advanced basal cell carcinoma (BCC). We report a case of a 67-year-old Australian man with metastatic BCC including pulmonary disease with malignant effusion who showed a dramatic complete response to vismodegib but subsequently experienced a recurrence of pulmonary disease, indicative of chemoresistance to vismodegib. This case is the first to illustrate chemoresistance in a patient with metastatic BCC, and demonstrates the need for closely monitoring metastatic BCC patients even after an apparently complete response.


PubMed | Victorian Melanoma Service
Type: Journal Article | Journal: The Australasian journal of dermatology | Year: 2014

Although there has been improvement in clinical diagnosis of pigmented superficial spreading melanomas (SSM), less common melanoma subtypes have different clinical features and may be more difficult to diagnose. The objective was to assess diagnostic accuracy for different melanoma subtypes.A retrospective review was made of a random selection of SSM, nodular melanomas (NM), desmoplastic melanomas (DM) and acral lentiginous melanomas (ALM) biopsied between February 2001 and May 2012 and referred to the Victorian Melanoma Service. Clinical differential diagnoses listed on pre-operative biopsy pathology request forms were recorded. Sensitivity for the diagnosis of melanoma was used as a marker of diagnostic accuracy.In total 111 SSM, 121 NM, 43 DM and 30 ALM were biopsied by 222 clinicians. Whereas diagnostic sensitivity for SSM and ALM were similar (77%, 95% CI 69-85% and 73%, 95% CI 58-89%, respectively) diagnostic sensitivity was lower for NM (41%, 95% CI 33-50%) and DM (21%, 95% CI 9-33%). Both NM and DM were diagnosed at greater tumour thickness (median 3.0mm and 4.0mm) than SSM and ALM (both median 1.0mm). Amelanosis was associated with lower diagnostic sensitivity for SSM (0 vs 82%, P<0.01), NM (19 vs 51%, P<0.01) andDM (10 vs 32%, P=0.07). Dermatologists were more accurate than non-dermatologists for NM (diagnostic sensitivity 57 vs 32%, P<0.01) and ALM (diagnostic sensitivity 94 vs 43%, P=0.02).Misdiagnosis of melanoma varies according to subtype and is particularly problematic for NM, DM and hypopigmented melanomas. Greater awareness of the different criteria required to diagnose these melanomas is needed.


PubMed | Skin and Cancer Foundation Inc, Victorian Melanoma Service and Australian Radiation Protection and Nuclear Safety Agency
Type: Journal Article | Journal: The Australasian journal of dermatology | Year: 2016

Australia has the highest incidence of skin cancer in the world, a preventable disease caused primarily by exposure to ultraviolet radiation (UVR) in sunlight. Health promotion strategies play a significant role in sun protection.To assess the understanding of a population sample as to the time of year that the sun was at its most burning in Melbourne, Australia.A cross-sectional study was performed using questionnaires completed at corporate skin checks, conducted on 668 participants during 2011 to 2013.Only a minority (n = 82, 12%) gave the correct theoretical answer; the summer solstice or 21-22 December, while another 38% (n = 254) correctly named December and January as the times when the UVR is actually highest. In all, 18% (n = 122) said February was the month when the temperature is hottest and 170 (25%) either mentioned the period May-August when UVR is negligible in Melbourne or had no idea, including saying all year round. There was no significant difference in this knowledge between different age groups.One-quarter of participants did not understand that sunburn was related to high levels of UVR, which occur in summer. Almost one-fifth associated the heat of February with the highest UVR. Understanding these concepts is important for Australians residing in cooler parts of southern Australia, as UVR levels may be high and yet the temperature may be relatively cool. There needs to be more emphasis on UVR in sun awareness campaigns to prompt sun-protective behaviour.


PubMed | Victorian Melanoma Service
Type: Journal Article | Journal: The Australasian journal of dermatology | Year: 2015

Information on the prognosis for patients with regional cutaneous melanoma metastases has been sparse and difficult to establish. In 2009 the American Joint Committee on Cancer (AJCC) melanoma staging has for the first time provided survival rates for patients who manifest intralymphatic metastases. We sought to validate the new staging system in this contemporary, prospectively collected cohort of patients following the development of cutaneous metastases as the first evidence of metastatic disease and explored the factors that influenced their prognosis.The Victorian Melanoma Service database was searched to identify all patients with cutaneous melanoma metastases. Patients who were found to have lymph node or visceral metastases at the time they were diagnosed with cutaneous metastatic disease were excluded. Survival curves were generated and univariate and multivariate assessments of prognostic factors associated with survival were performed.In total, 72 patients presented with cutaneous metastases as the first evidence of metastatic disease. The median melanoma-specific survival of patients with only regional cutaneous metastases (n=56) was 5.07 years and their 5-year survival rate was 52%. Distant cutaneous metastases and thickness of the primary melanoma were found to be significant negative predictors of survival.We were able to validate the new AJCC melanoma staging system survival for patients with cutaneous metastatic disease. Patients presenting with regional cutaneous metastases have a much better prognosis than those with distant cutaneous metastases.

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