How the Sydney melanoma unit became a centre for multidisciplinary melanoma treatment and research

The activities of the Sydney Melanoma Unit (SMU) commenced in the
mid 1960’s, when Dr Gerald Milton of the Department of Surgery at
the University of Sydney recognised that there was a need for a special
clinic for patients with melanoma [1]. Sydney is the largest city in
Australia, a country with a very high incidence of melanoma, and the
SMU soon became the major referral centre for melanoma patients
from throughout New South Wales. Dr Milton also recognised that
data collection was important to understand the disease better and
improve treatment, and with the assistance of Dr Helen Shaw the
SMU database was established. As patient referrals to the SMU increased
rapidly in number, it became apparent that to provide complete
melanoma care it would be necessary to offer chemotherapy,
radiotherapy and palliative care, and steps were taken to provide these
additional services. A domiciliary nursing service for patients with
advanced disease was established, at a time when the value of such
services had not been generally recognised. The research activities of
the SMU were facilitated by the establishment of the Melanoma
Foundation within the University of Sydney, providing funds for research
infrastructure, as well as for public education. Approximately
1,300 new patients with melanoma are now referred to the SMU each
year, and its database now contains information on over 25,000 patients.
The SMU provides integrated multidisciplinary care for patients
with melanoma. This care is provided not only by surgical oncologists
who undertake surgical treatment of patients with primary melanomas
and recurrent disease but also by medical oncologists, radiation oncologists,
nuclear medicine physicians, histopathologists, radiologists,
palliative care specialists and oncology nurses, all with particular
expertise and experience in the diagnosis and treatment of patients
with melanoma. A weekly multidisciplinary clinical review meeting is
attended by all SMU clinicians, nurses and clinical research staff. This fosters not only a strong spirit of unity and cohesion but also a
high level of adherence to agreed treatment guidelines and clinical
trial protocols. At these meetings evidence-based treatment policies
are developed, with input from all members of the multidisciplinary
team.
The appropriate care of patients with melanoma is critically
dependant on high calibre pathology, and the SMU was fortunate to
have Dr Vincent McGovern as part of its multidisciplinary team in
the early days, and subsequently Dr Stanley McCarthy and Dr
Richard Scolyer, all internationally acknowledged experts in the
pathology of melanocytic tumours. Over the past two decades,
clinical trial activity at the SMU has expanded exponentially, with
major contributions to important international multicentre studies.
The willingness of SMU patients to enter these trials has been largely
because they have been impressed by the skill, professionalism and
dedication of the multidisciplinary team members who care for them.
The SMU has identified key neurosurgeons and thoracic surgeons
with whom it works closely, and medical oncologists, clinical
immunologists, radiation oncologists, nuclear medicine physicians,
radiologists and palliative care specialists are all part of the team. An
offshoot of the SMU provides diagnostic services for pigmented skin
lesions, and clinical and laboratory research is undertaken by SMU
clinicians and researchers who are based at two other centres
(Westmead Hospital in western Sydney and the Mater Hospital in
the city of Newcastle).
The SMU provides a disease-specific specialist clinical service that
has been highly successful. Key elements contributing to this success
have been the sense of unity and purpose fostered by weekly multidisciplinary
meetings, and the strong commitment of staff to clinical
and basic research as a concomitant of high quality clinical care. Also
of great importance has been the careful prospective collection of data,
which has provided improved understanding of the natural history of
the disease and has allowed the development and critical assessment of
new treatment protocols.