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Melanoma Service Saved
Written by Dr Mark Hanikeri
Tuesday, 29 August 2017

25082017-Melanoma-Skin-CheckWAMAS has facilitated standardisation of management opportunities for patients referred to the service, regardless of insurance status or postcode…

The Western Australian melanoma advisory service (WAMAS) was established in 2000 at St John of God Hospital in Subiaco and has been jointly funded by the Department of Health (DoH). Its aim is to provide multidisciplinary advice for melanoma patients with advanced disease without the need for interstate travel.

WAMAS is populated by specialists from all aspects of melanoma treatment including surgeons, dermatologists, oncologists, pathologists and radiologists. They provide their time and services, essentially pro-bono. WAMAS has also collaborated with organisations such as the Cancer Council WA through the WA Clinical Oncology Group, the Melanoma Institute of Australia (MIA) and MelanomaWA, to provide accurate and contemporary advice and education opportunities for patients and clinicians.

Since 2008, there have been plans to transition WAMAS into a treatment and advisory service, modelled on MIA, and relocating the service to the Perkins Institute. This prompted the DoH to review funding for the service. Based on this review, the DOH informed WAMAS that it would no longer fund a state-wide melanoma-specific advisory service.

The proposed alternative was a public hospital multidisciplinary team based at Sir Charles Gairdner Hospital to assess general skin cancer patients, modelled on a similar clinic at Fiona Stanley Hospital. There were no plans to provide a service for patients with melanoma in the private setting, in rural areas or in the eastern metropolitan area.

The DoH decision was met with objections from WAMAS, MelanomaWA and the Cancer Council. Thankfully, following a meeting last month with the Director-General for Health, Dr David Russell-Weisz, that earlier decision was reversed pending further negotiations.

Over the past decade profound advances in melanoma management have been made. Surgical procedures including sentinel node biopsy together with access to PET-CT have led to improvements in staging, while new adjuvant medications including BRAF inhibitors and immune modulators have improved the prognosis of patients with advanced disease.

These modalities rely on clinical research to demonstrate their efficacy and benefit to patients and the community. The pace of treatment advances has made it difficult for clinicians to keep up with optimum care for these patients. WAMAS has facilitated standardisation of management opportunities for patients referred to the service, regardless of insurance status or postcode, including diagnosis confirmation, appropriate surgical and medical care and access to clinical trials.

Currently, melanoma management recommendations are being standardised across Australia. These prescribe that patients who have a primary melanoma with a Breslow thickness over 1mm or metastatic disease are referred to a multidisciplinary team. This has now become the standard of care for these patients.

The new, centralised, state-wide melanoma service based at the Perkins Institute is yet to be named but will be launched later this year and will commence activities from January 1, 2018.

A GP education event will be held on November 22.

By Dr Mark Hanikeri