GPs essential to early diagnosis and treatment of melanoma

As Australian patients begin to spend more time in the sun, the Royal Australian College of GPs (RACGP) has urged patients to organise a skin check with their GP to ensure dangerous skin cancers are detected and treated early.

The latest edition of the Australian Journal of General Practice (AJGP) focuses on skin cancer, including articles on managing patients with newer treatments and exploring the risk of overdiagnosis versus the benefit of earlier detection.

Medical oncologist Associate Professor Alexander Menzies and co-authors discussed how collaboration between GPs and oncologists and newer drug therapies has led to earlier treatment and reduced recurrence of melanoma after surgery, and provided GPs with a guide to recognising and managing adverse events from therapies.

Associate Professor Menzies, an oncology researcher with Melanoma Institute Australia and the University of Sydney, said advanced melanoma, once a terminal disease, now had a 50% long-term survival rate due to the success of drugs such as immune-checkpoint inhibitors (ICIs).

“Historically, patients facing an advanced melanoma diagnosis had a median overall survival of about six months. That’s shifted dramatically with the introduction of ICIs a decade ago,” he said.

“Recent achievements in the treatment of advanced melanoma are now influencing early-stage treatment, reducing the risk of recurrence after surgery. GPs are crucial in referring newly diagnosed patients as well as recognising and managing immune-related adverse effects that can occur with immunotherapy and general comorbidities.

“Indications for use of ICIs are expanding, but they do have a risk of immune-related adverse events. GPs provide comprehensive care for cancer patients during immunotherapy, so it’s vital GPs have a clear understanding of potential adverse events and how to manage them.”

Overdiagnosis of melanomas that were unlikely to cause further harm was explored in a separate AJGP paper which highlights the challenge GPs face when assessing melanomas as well as a potential upside to overdiagnosis.

“It’s not possible with current technology to identify which melanomas will remain harmless, so overdiagnosis is the reality,” corresponding author, GP, and University of Queensland Clinical Professor Cliff Rosendahl said.

“We found however that excess deaths from melanoma decrease with increased melanoma incidence. That means a possible benefit of overdiagnosis is the reduction in excess deaths where melanoma is diagnosed most frequently. Previous research also shows GP subspecialisation, dermatoscopy use, education, and experience also reduce the number of benign lesions excised for each melanoma diagnosis.”

Skin cancers are around 80% of all newly diagnosed cancers in Australia. Previous research also found just one in five patients can identify a malignant melanoma as a lesion of concern, making regular checks with a GP key to prevention.

RACGP President Dr Nicole Higgins said GPs have an ever-increasing role to play in early diagnosis and referral.

“GPs manage more melanomas than dermatologists or surgeons in Australia, so it’s vital we have the latest evidence.

“GPs work closely with oncologists during our patients’ treatment to deliver timely and effective care. We’re calling on the Federal Government to fund ‘living’ guidelines for preventive care so we always have access to the latest research.”

The AJGP aims to provide Australian GPs with relevant, evidence-based, clear information to assist them in providing the highest quality patient care. GPs can also use is clinical challenges for continuing professional development.

~ENDS