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Stalking a stealthy killer

Australia recently regained the unenviable title of the melanoma capital of the world, knocking New Zealand off the top spot. But Australian researchers are also leading the way in developing a blood test that can catch the deadly cancer in its early stages, before it has a chance to spread around the body.

Australia has the highest rate of melanoma in the world.

Among skin cancers, melanoma has a dual distinction: it is often hard to catch early, before it has spread to other parts of the skin or other organs, and it is particularly deadly.

As melanoma cases rise around the world, with 132,000 new cases diagnosed each year, Australia has been hit especially hard. The nation features the world’s highest melanoma rate. Each year, the disease kills more than 1,700 people in Australia – more than are killed in traffic accidents – and is diagnosed in thousands of others.

Even with melanoma being discovered in more and more people, physicians and researchers worry that the current tools used for finding it are inadequate.

Clinicians perform biopsies on moles or suspicious-looking areas of skin. Pathologists then scan the sample for signs of the disease.

The method is invasive, taking one square centimetre of skin or more. And it is expensive, costing the Australian health system $73 million annually. What’s more, three out of every four biopsies come back negative.

For these reasons, researchers around the world have been in search of a test that could identify melanoma earlier, and with more accuracy.

Now, in a breakthrough that could save thousands of lives, ECU researchers have devised a blood test that can detect early-stage melanoma in about 80 per cent of patients.

The discovery is the result of a scan that ECU researchers conducted on more than 1,600 types of antibodies, with a goal to identify a combination of 10 antibodies that can best indicate the presence of melanoma in the blood. They are now developing a blood test that scans for antibodies the body makes when melanoma first presents itself.

“The body starts producing these antibodies as soon as melanoma first develops, which is how we have been able to detect the cancer in its very early stages with this blood test,” says Dr Pauline Zaenker, from the ECU Melanoma Research Group.

“No other type of biomarker appears to be capable of detecting the cancer in blood at these early stages.”

Researchers at ECU analysed the blood of 104 melanoma patients and 105 healthy people, the latter serving as a control group. They found 139 possible antibodies that were expressed at higher levels in patients with melanoma. The research group then used high level statistical analyses to identify a group of 10 ‘autoantibodies’ – weapons the body usually uses to ward off illnesses – and found that they could be used to detect early-stage melanoma in 79 per cent of patients.

Such a tool could be of particular value to people who present additional diagnostic difficulties, such as those whose skin contains 100 or more moles, or colourless amelanotic tumours, or thin early stage melanomas, as well as those patients at especially high risk of contracting the disease.

It also might allow doctors to reach more patients, including those in remote or rural areas, and others who avoid skin cancer checks because of a fear of biopsies.

Professor Mel Ziman, head of the ECU Melanoma Research Group, says: “A blood test would give doctors an additional tool to have more diagnostic certainty prior to a biopsy.”

Findings must now be tested among larger groups of patients, Ziman adds.

The research group is looking to perform a clinical trial with 1,000 participants who have a suspicious lesion thought to be a melanoma, and from whom blood will be collected prior to the collection of the biopsy. Then, the team will compare the blood test findings with biopsy results.

“We’ll be able to identify how accurate our test is and perhaps improve its accuracy to 90 per cent, which is what should be expected of diagnostic testing,” Ziman says.

“By testing more people, we hope to find more or better antibodies, which will bring up the accuracy rate.”

Says Zaenker: “Patients who have their melanoma detected in its early stage have a five-year survival rate between 90 and 99 per cent, whereas if it is not caught early and it spreads around the body, the five‑year survival rate drops to less than 50 per cent.”

“This is what makes this blood test so exciting as a potential diagnostic tool because it can pick up melanoma in its very early stages, when it is still treatable.”

For more information, visit ecu.edu.au/research/melanoma.

Adam McEvoy, 51, a senior manager in the oil and gas industry, had melanoma diagnosed in August 2018.

“I only started having my skin checked about five years ago when the number of lesions had started to increase. I was constantly having things cut out and burnt off, a legacy of growing up outside in the sun, in Africa.

“At one of my appointments, my doctor did four biopsies at once. There were two spots on my face that he was particularly concerned about; the others not so much. But in fact it was one of the lesions that hadn’t bothered him that came back as being a melanoma.

“That diagnosis is extremely confronting and daunting. I was sitting in bed with a cup of coffee when the call came through. I was stunned. I thought it couldn’t possibly be right.

“My doctor acted quickly. He removed the melanoma within days of finding it. Even though it was in situ, it still required a substantial incision and deep stitches. Fortunately they got it all out and I’ve been carefully monitored ever since.

“This new research to develop a blood test for melanoma is extremely significant. It has the potential to change the lives of millions of people worldwide.

“Besides the obvious benefits of early detection, a test like this is non-invasive, inexpensive, easy to perform and delivers results quickly. It can save hundreds of thousands of dollars in doctors’ fees and biopsies.

“It’s life-changing.”

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