March 2007

‘Super’ melanomas under microscope

Rapidly-growing melanomas that no longer fit the classical description of melanomas—and that can potentially kill in a matter of weeks—are the focus of a study led by Alfred Hospital researchers.

The study lifts the lid on fast-growing melanomas which, the researchers said, could occur in anyone.

Study leader and Alfred Dermatology Registrar Wendy Liu said it showed just how aggressive melanomas could be and reclassified them into groups according to their biological behaviours.

‘Common melanomas are asymmetric, irregularly pigmented and, more often, biologically less aggressive,’ Dr Liu said.

‘With these rapidly-growing melanomas, we find they are more often red in colour, symmetrical and elevated and are associated with more aggressive biological behaviour.’

Dr Liu said because of their rapid growth, there is only a small window of opportunity to capture these melanomas in their early stage of development.

‘The fact that they look uncharacteristic of melanomas and do not necessarily occur in people who are molely and freckly, adds challenge to early detection because doctors and patients don’t suspect them to be melanomas,’ Dr Liu said.

‘They can occur in anyone but they are more commonly found in those without large numbers of moles and freckles—and in elderly men.’

Head of the Victorian Melanoma Service at the Alfred Associate Professor John Kelly said the rapidly-growing melanomas often appeared as a new lesion rather than starting in a mole formation.

‘We’ve come to equate melanomas as being brown or black but the fast-growing melanomas do not fit the description encoded by the ‘ABCD rule’ of asymmetry, border irregularity, colour irregularity and large diameter.’

While sun smart campaigns had done a good job of increasing awareness of the dangers of melanoma there was a fresh need to promote awareness of these less common, but more aggressive, forms of melanomas—both among health professionals and the general public, Associate Professor Kelly said.

‘We are hoping to shift the focus onto the more rapidly-growing and biologically-aggressive melanomas, which can kill rapidly.

‘If a person notices a new rapidly-growing skin lesion, regardless of colour, shape and the individual, self-perceived risk factor for melanoma, he should be promptly assessed by a doctor.’

The Victorian Melanoma Service is the only fully-multidisciplinary consultative centre for the management of melanoma in Victoria.

Established in 1994, the service provides a comprehensive assessment for people with melanoma by bringing together all the specialties involved in its treatment.

It also maintains an active program of research in melanoma.

Associate Professor John Kelly said the centre aimed to provide patients and referring doctors with full information and advice about melanoma and the most appropriate way to treat it.

‘Patients are assessed by experts in dermatology, pathology, medical oncology, radiation oncology, general surgery, plastic surgery and psychology.

‘Wherever possible we aim to involve patients’ own doctors in continuing their management with our support.’

Appointments are by referral only.