Abstracts: innovations and models of best practice in New Zealand
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Nine Summit participants have been selected to provide a 5-minute presentation on an innovative initiative, research project or model of best practice for melanoma prevention, diagnosis, treatment or care in New Zealand. Abstracts of these presentations are as follows:
SES youth stats: What do young New Zealanders think about melanoma, tanning and skin cancer risk
The Skin Cancer Control Steering Group has decided that young people in their teens and early twenties will be the primary audience for a sun safety public health campaign for the next three years. The Health Sponsorship Council is now developing a youth-targeted campaign.
The 2010 Sun Exposure Survey, conducted in March 2010, gathered some baseline data about young people’s knowledge and attitudes about tanning, melanoma and risk factors for the development of melanoma/skin cancer. This presentation will compare the responses of the “teen” (13-17 year old) sample with those of the younger adult (18-24 years) group.
Rebecca Gray, Researcher, Health Sponsorship Council
UVI redevelopment: New Zealand and Victoria, Australia collaborative research
The UV Index is the recommended international measure for communication of solar ultraviolet radiation (UVR). Previous audience research has shown that the UV Index is not well understood, and that people want to be given clearer behavioural recommendations for different times of the day. The Health Sponsorship Council and Cancer Council Victoria (both of whom communicate UVR information) have commissioned a Trans-Tasman online survey to test new UV Index/ UV Alert designs. This presentation will summarise the findings of the research and explain the process for bringing the new designs to the public through different types of media.
Rebecca Gray, Researcher and Wayde Beckman SunSmart Project Manager, Health Sponsorship Council
“The dark shift” – implications for skin cancer prevention
Background:
Skin colour is related to skin cancer risk. Valid self-report would assist appropriate cancer control targeting.
Methods:
Self-reported unexposed skin colour (using NZ Sun Exposure Survey categories) and spectrophotometer measures were obtained from 265 university students.
Results:
Self-report correlated significantly with spectrophotometer measures (P<0.001), but biases toward overestimation of pigmentation were found. These ranged from 36% of the self-identified fair skin group to 77% of the medium skin group identifying with darker colour categories.
Significance:
The observed bias towards overestimation of skin colour needs to be taken into account or it may contribute to undermining skin cancer prevention efforts.
Tony Reeder, Director, Cancer Society Social & Behavioural Research Unit, Department of Preventive & Social Medicine, University of Otago, Dunedin. Other authors: Hammond VA, Gray A.
Have melanoma prevention programmes caused some melanomas?
For more than a decade several studies have found sunscreen use to be more common in melanoma patients. While increased sunscreen use is expected with greater sun exposure, this does not appear to completely explain the association. Sunscreen use has been found to significantly change behaviour in the sun, for example, by lengthening sun exposure times. UVA is also being assessed for its melanomagenic potential and formulations of sunscreens have changed over time. The association of sunscreen use and melanoma will be reviewed and estimates of the numbers of melanoma in New Zealand induced by sunscreen use, if causal, presented.
Brian Cox, Associate Professor of Cancer Epidemiology, Hugh Adam Cancer Epidemiology Unit, Department of Preventive & Social Medicine, University of Otago, Dunedin
Indoor tanning legislation lacking
A clear mechanistic association between indoor tanning and development of melanoma has been established. A 75% increased risk of melanoma with sunbed use before 35, and designation by the WHO as a class one carcinogen alongside asbestos, has led to a number of countries swiftly moving to implement restrictions on sunbed use. France, Germany, Austria, Finland, Britain, the USA and Australia have introduced restrictions on minors. New Zealand as a world leader in melanoma statistics is embarrassingly lagging behind this international progress. This paper will present details of the current international position and provide recommendations for legislation in New Zealand.
Ben Tallon, Dermatologist/Dermatopathologist, Tauranga Hospital
The Waikato virtual lesion clinic
Skin cancer is very common in New Zealand and hospital lesion clinics struggle with the volume of referrals received. This results in long waiting times for diagnostic assessment leading to delayed treatment. Waikato Hospital has trialled a teledermoscopy service to help manage waiting times. Analysis of the first 100 patients show that 97% did not require a hospital appointment to establish the diagnosis. Waiting times were reduced by two thirds. Eighteen patients with skin cancers or suspicious lesions {melanoma (5), atypical naevi (2), nmsc (10) and other (1)} were placed directly onto surgical waiting lists. Surveyed patients have been highly satisfied and confident with the service. Virtual lesion clinics can allow hospitals to provide a better, quicker and more convenient service.
Amanda Oakley, Clinical Associate Professor, and Marius Rademaker, Clinical Professor, Waikato Clinical School, Department of Dermatology, Health Waikato
Melanomas are notoriously drug-resistant
Melanomas are notoriously drug-resistant, limiting the effectiveness of chemotherapy. ABCB5 is a protein found on the surface of melanoma cells, which has been shown to pump anti-cancer drugs out of cells cultured in the laboratory. Therefore it is thought that ABCB5 may contribute to melanoma drug resistance. We have used a model laboratory yeast to investigate the pump properties of ABCB5 and hope to use the yeast to find inhibitors of ABCB5 which could improve the effectiveness of chemotherapy.
Dr Ann R Holmes, Senior Research Fellow, Department of Oral Sciences, University of Otago
Co-authors: Dr Mikhail V Keniya, Dr Masakazu Niimi and Professor Richard D Cannon.
The melanoma service improvement project
The Melanoma Service Improvement Project was initiated by clinicians and staff at North Shore Hospital to improve the patient journey for those with melanoma. The project’s objective was to review the journey that a patient typically undertakes as they progress through the diagnosis and management of their melanoma, and to identify opportunities for improvement. This presentation will highlight some of the key findings of the project along with its final recommendations, including the development of a melanoma FAST communication toolkit (Fast, Adjustable, Simple, Translatable).
Anna Brown, Research Nurse Specialist, Department of Surgery, Waitemata District Health Board
A novel approach to palliation of difficult-to-treat cutaneous melanoma metastasis: A case series of 3 patients
Purpose - Disseminated dermal melanoma metastasis often presents a unique management dilemma for all clinicians that treat melanoma. Although the primary modality for treatment remains surgical, adjuvant therapies such as radiotherapy are often called into use for palliation in stage IV disease. The treatment of disseminated dermal deposits presents a particular challenge for which we have had very favourable response with the use of brachytherapy or HDR (high dose radiation).
Methodology - Waikato Hospital in New Zealand offers brachytherapy to palliative patients as an option to control cutaneous metastases.This case series consists of three patients who underwent treatment with brachytherapy for cutaneous metastases delivered by surface moulds.
Results - no further recurrence in any of our patients with a maximum time of 21 months.
Conclusion - we would advocate the use of brachytherapy in certain clinical situations as a useful palliative option for disseminated dermal melanoma metastases which are otherwise very difficult to control and where other options are contraindicated.
Zachary Moaveni, Plastic Surgeon, Middlemore & Waikato Hospitals
Other Authors: Fiona Smithers; Zachary Moaveni, FRACS (plas); Charles De Groot, FCRadOnc (SA)
