Cutaneous Melanoma Diagnosis Down Under

In countries with historically large settler populations from Europe, skin cancers – particularly melanoma – are among some of the most significant health risks, as exemplified by Australia, which has the highest rates of skin cancer in the world (1). Cutaneous melanoma is also common among Australians – and both under- and overdiagnosis have serious, potentially deadly, implications for patients throughout the Australian healthcare system.

“Melanoma research is a significant issue for clinical service provision and the Australian public,” says Jessica Logan, Research Fellow from the University of South Australia, one of several researchers trying to throw the complexities of correct diagnosis (2). “Cancer treatment is always at the forefront of the news and academia, but we wanted to highlight [that] melanoma diagnosis can also present significant difficulties.”

After speaking with patients and their families, the researchers realized that diagnosis was an often overlooked and underrepresented topic. “We felt the best approach was to highlight the difficulties facing melanoma diagnosis before we could make inroads into providing new tools to assist in its accurate diagnosis,” says Logan.

One root cause of the problem is the high level of heterogeneity. The authors explain how routine histology – combined with supporting tests such as immunohistochemistry (IHC) – are used as a standard in melanoma diagnosis. But note that, though IHC can help distinguish melanocytic from non-melanocytic tumors, current markers gleaned through IHC cannot consistently differentiate melanomas from benign melanocytic lesions. To improve the diagnostic accuracy and patient outcomes, the authors state, pathologists must have melanoma-specific markers that can reveal useful information about the state of disease.

To identify reliable markers, a change in thinking and approach is needed, they say. Any marker candidates must be analyzed and eventually shortlisted into a group with the greatest potential. Only the best candidate should be chosen for further development and their ability to identify unique pathological features. And, of course, the authors note, these candidates must be cross-validated through larger cohorts and highly-annotated biobanks.

The paper has garnered significant media attention, according to Logan, so it looks like their mission to raise awareness of inaccurate melanoma diagnosis can be considered a success.