GPs alongside oncologists key for melanoma outcomes

Drug therapies for the treatment of melanoma are advancing, and many now play a role for the treatment of earlier stage disease, according to new research.
 
Published in the latest edition of the Australian Journal of General Practice (AJGP), which focuses on skin cancer, the paper summarises the latest evidence base in melanoma care, with guidance for when GPs should refer patients to medical oncologists as part of the multidisciplinary team.  
 
Breakthrough drug therapies, such as immune-checkpoint inhibitors (ICIs), and partnerships between GPs and oncologists have resulted in earlier treatment and reduced recurrence of melanoma after surgery, the authors highlight.
 
Associate Professor Alexander Menzies, a medical oncologist and co-author of the paper, said GPs have an essential role in best care alongside oncologists.
 
‘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,’ he said.
 
The AJGP paper provides guidance on managing these adverse effects, highlighting the collaborative role of GPs and oncologists in advancing melanoma care and improving patient outcomes.
 
Early referral for the treatment of melanoma is crucial, the authors write, while ‘recognition and prompt management of immune-related adverse effects is vital’.
 
Once considered a terminal disease, advanced melanoma now boasts a 50% long-term survival rate due to the success of new drugs like ICIs, according to Associate Professor Menzies. But as with all therapies, he said GPs should be aware when to identify and manage associated adverse events.
 
‘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.
 
‘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.’
 
Australia remains the country with the highest rates of skin cancer in the world, with skin cancer accounting for the largest number of all newly diagnosed cancers each year, at around 80%.
 
Melanoma incidence rates have increased from 53 cases per 100,000 people in 2000, to an estimated 70 cases per 100,000 people in 2024. Globally, rates are projected to increase over the next decade.
 
Meanwhile, a recent study found that most people are unable to self-diagnose skin cancer on their own bodies, with only one in five able to identify a malignant melanoma as a lesion of concern, further highlighting GPs’ important role in promoting and conducting regular skin checks.
 
RACGP President Dr Nicole Higgins said GPs remain central to early diagnosis and referral for skin cancers, and ‘work closely with oncologists during our patients’ treatment to deliver timely and effective care’.
 
And while the RACGP’s Red Book has the most up-to-date recommendations on cancer screening, the college is calling for further funding to make it a ‘living guideline’ to be updated whenever new evidence-based advice emerges.
 
This follows on from previous calls for enhanced funding to enable GPs to stay at the forefront of medical best practice by using the latest published evidence.
 
‘GPs manage more melanomas than dermatologists or surgeons in Australia, so it’s vital we have the latest evidence,’ Dr Higgins said.
 
‘We’re calling on the Federal Government to fund “living” guidelines for preventive care so we always have access to the latest research.’
 
The September issue of AJGP also includes articles on managing patients with newer treatments for melanoma and exploring the risk of overdiagnosis versus the benefit of earlier detection.
 
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AJGP early detection melanoma multidisciplinary team care preventive health skin cancer