Richard A. Scolyer
Co-Medical Director, Melanoma Institute Australia; Senior Staff Specialist, Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital & NSW Health Pathology; Conjoint Professor, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Australia
Biggest challenge in pathology? I think the biggest challenge is developing techniques to integrate various forms of data to make the correct diagnosis and optimise the treatment for individual patients (ie. evolving personalized medicine). While we made incredible advances over the last three decades since immunohistochemistry was developed and became a standard form of treatment, now molecular and genetic testing are also included. Image analysis of scanned slides is now being developed and this will no doubt provide some further changes to the field but it will be challenging to integrate this into standard practice. An even bigger challenge will be the use of AI to improve the accuracy of diagnosis and treatment for individual patients.
Book recommendation? Perhaps it is a bit controversial but I would suggest my autobiography, “Brainstorm,” which is due to be released shortly. I was diagnosed with a very poor prognostic form of glioblastoma (IDH wildtype unmethylated with a whole host of other adverse prognostic factors), in May 2023. Treatment and outcomes haven’t been improved in almost 20 years, and it is essentially incurable.
In contrast, in my field (melanoma) we have made incredible advances in the treatment of advanced stage melanoma patients over the past 10–15 years. Previously, 5-year survival rates were less than 5 percent, but now are more than 50 percent, principally because of breakthroughs in the use of immunotherapy. We have also proven that immunotherapy given before surgery improves response rates (as judged by pathological assessment) and survival in stage III melanoma patients.
I am the first patient in the world to be treated with neoadjuvant combination immunotherapy to generate scientific data that may change the field. The scientific data that has already been generated from my tumor has sparked interest in the field and a clinical trial is currently being developed to test this in a robust manner. My book will be released on November 1, 2024.
Deciding which problems to tackle? I chair Melanoma Institute Australia’s multidisciplinary team meeting/tumor board meeting bi-weekly. During the course of this meeting, important clinical problems/research questions are often raised which need addressing to improve patient outcomes. Coming from Australia where melanoma has the highest incidence of any country in the world, it is important that we address this problem. With our large research database, enormous biospecimen bank and numerous difficult consultation cases, we have extraordinary opportunities to tackle some very challenging melanoma problems. Nevertheless, prevention is always better than cure, so it is also important that we get the sun-smart message out in the community to reduce the incidence of melanoma. The importance of early detection is another issue that we should address as doctors.
