2016 Australasian Skin Cancer Congress

A very important meeting that I recently attended was the 2016 Australasian Skin Cancer Congress.

At this congress many very significant aspect of skin cancer were considered, including: the changing landscape of melanoma reporting; the management of metastatic melanoma: personalised approach to treating melanoma with radiotherapy; biological pathways to melanoma; dermoscopic correlations with histology; possible cures for melanoma; gamma knife radio surgery for melanoma brain metastasis;  side effects of targeted melanoma therapy; sentinel lymph node biopsy; adjuvant systemic therapy for melanoma, amongst many more very important topics.

There was a very moving description of the melanoma experience by a patient who grew up in the Northern Territory, and had very strong sun exposure through her younger life. A few years ago she had an early-stage melanoma removed, and was considered clear of the disease. However some time later melanoma was found in her lymph glands, and even after surgery and radiotherapy she had the disease in many areas of her body. She was then offered an experimental treatment, which at present seems to have been successful. She discussed the importance of melanoma education and the need for culture change because of the varied patient experiences, as well as the need for cutting-edge knowledge for GPs, skin cancer clinics and oncologists.

Another talk that was very interesting was on the changing landscape of melanoma reporting. This was by a dermatopathologist who discussed advances such as molecular techniques and dermatoscopy, which impact on the histological and immunohistochemical reporting of melanoma.

Two new therapeutic approaches have revolutionised the management and outcome of metastatic melanoma: MAP kinase inhibitors and immune checkpoint inhibitors. These new therapies herald a new era in the treatment of melanoma, although also bring challenges such as the autoimmune toxicities and non-conventional response patterns. Future advances will require the use of biomarkers for patient selection and the use of new antagonists and agonists of the immune system.

The personalised approach to treating melanoma with radiotherapy was also discussed, whereby it has been found that some melanomas are resistant to radiotherapy but others are sensitive, and which leads to either the over-treatment or under-treatment of patients, with subsequent consequences on quality of life.  Recently molecular markers had been identified on melanoma cells that might assist in predicting radio-sensitivity.

Of particular interest was the serological detection of tumour markers. This is because melanoma is the fourth most common cancer in Australia, with about 13,000 new cases and more than 1600 dying in 2015.The 5-year survival is 91%, rising to 99% if the melanoma is detected in-situ. However, if distal metastasis occurs the 5-year survival drops to 15%. This is why early detection of melanoma is so important.

There were surgical updates on closing large defects and nerve blocks; key solutions to complex surgical problems; large facial defects; and simple local skin flap repairs.

The “facts and fictions” of Dysplastic Naevuswere considered, as was the relationship between the total number of naevi and the risk of melanoma. This relationship is, however, is still to be clarified with respect to benign melanocytic lesions and melanoma morphology.

How sentinel lymph node biopsy affects treatment was discussed, as this is the most accurate method of staging patient, and offers prognostic information.   

Finally, adjuvant systemic therapy for melanoma was discussed. Although surgical excision of melanomas often results in cure, it is an aggressive cancer with a high risk of systemic relapse, and death. Work is being done on targeted adjuvant immunotherapy, which might increase survival.