Core 1 aims to develop, apply and evaluate a comprehensive model of risk stratification and surveillance of individuals at elevated risk of melanoma, to improve early detection of melanoma and subsequent health outcomes, and reduce health system costs. This core builds on our research of melanoma high risk clinics showing that six monthly total body photography, dermoscopy and short-term monitoring was a cost-effective strategy for the management of individuals at very high risk of melanoma1,2.
The Core 1 research will include risk prediction modelling, implementation of risk-stratified surveillance as a new model of care in the dermatology clinics across different centres, evaluation of implementation, clinical and psycho-social outcomes, and epidemiological and decision-analytic modelling to explore optimum cost-effective screening and surveillance strategies.
Tailored surveillance project
Individual risk of melanoma differs widely between people and yet melanoma screening and surveillance strategies mostly rely on a one-size fits all approach. Melanoma risk prediction tools enable clinicians to more accurately advise patients on their risk of developing a first or subsequent melanoma based on sun exposure, phenotypic, genetic and histopathological risk factors. Knowing this personalised melanoma risk information can serve as a motivator for improved sun protection and skin self-examination behaviours, and permit tailoring of the frequency of surveillance follow-up visits and use of surveillance technologies (such as total body photography or teledermatology) according to risk level. In this project, we seek to evaluate the implementation of personalised melanoma risk assessment and tailored patient education and skin surveillance in these dermatology clinics, specifically by evaluating the acceptability, feasibility and fidelity of the more systematic approach to tailoring patient clinical management, and its impact on sun protection and skin examination behaviours, detection of new melanomas and other skin cancers, and relevant costs. We also seek to prospectively validate the risk prediction model over 10-years of follow-up using linked data.
High Risk Clinics
Our previous research has shown that a program of specialised surveillance for people at very high risk of melanoma that includes 6-monthly visits, total body photography and sequential digital dermoscopy imaging, resulted in earlier diagnosis and fewer excisions under a careful ‘wait-and-watch’ approach, and cost savings for the health system (Watts CG, Cust AE, Menzies SW, Mann GJ, Morton RL. Cost-Effectiveness of Skin Surveillance Through a Specialized Clinic for Patients at High Risk of Melanoma. J Clin Oncol 2017;35:63-71). In this project, we seek to analyse data from High Risk Clinics at the Melanoma Institute Australia, Westmead Hospital, RPA Hospital, and Newcastle Skin Check, to examine the outcomes and cost-effectiveness in different clinical settings.