Westmead Hospital plastic surgeon develops new tool to fight deadly melanoma

Westmead Hospital plastic surgeon Alex Varey. Picture: Sydney Health Partners

Doctors have been given another weapon in the fight against skin cancer thanks to the work of Westmead Hospital plastic and reconstructive surgeon Dr Alex Varey.

A team led by Dr Varey and Associate Professor Serigne Lo from Melanoma Institute Australia has developed an online calculator to predict the risk that a patient’s primary melanoma has spread to nearby lymph nodes.

Melanoma is a serious form of skin cancer that affects about one in 17 Australians. To find out if it has spread, clinicians will examine the first lymph node (known as the “sentinel” node) to see if melanoma cells are present, which indicates it has spread and affects the patient’s treatment plan.

The tool calculates risk based on a range of factors entered by the treating doctor.

The team’s research, funded by Sydney Health Partners and published in the Journal of Clinical Oncology, found the calculator has the potential to better identify melanoma patients who are most likely to benefit from a sentinel node biopsy, as well as those least likely to benefit.

“One of the big questions was, can we better predict which patients will be at significant risk of having their cancer spread to their lymph nodes?” Dr Varey said. “That’s what this calculator aims to do.

“The calculator takes into account five pieces of basic information about the melanoma and the patient’s age to determine their individual risk of the cancer having spread to their lymph nodes.

“This means that patients deemed at low risk of disease spread can potentially avoid having a sentinel node biopsy, which sometimes has complications and usually requires a general anaesthetic.”

The research team used established international calculators as a starting point, tailoring them to Australian demographics using patient data from Melanoma Institute Australia’s extensive database built up over a 50-year period.

Their research showed it provided considerably more accurate predictions than were previously available.

The calculator has been trialled at sites including Royal Prince Alfred, Royal North Shore and Westmead Hospitals with enthusiastic responses from clinicians and their patients.

“The calculator enables clinicians to have better informed discussions with their patients based on each individual’s percentage risk, rather than a few simplistic criteria that only approximate the risk of disease spread to the lymph nodes,” Melanoma Institute Australia co-medical director Professor Richard Scolyer said.

“The main benefit of the calculator is likely to be for those deemed to be at low risk of disease spread, who can safely forgo a sentinel node biopsy. This is of benefit particularly to older patients who are less likely to have melanoma spread to their lymph nodes, but who are at increased risk of complications from extra surgery and general anaesthesia.”

Avoiding unnecessary procedures is good for patients, clinicians and health services.

Learn more about the warning signs for melanoma and other skin cancers at the Cancer Council Australia website.

The Sentinel Node Biopsy Risk Calculator is available for clinician use here.