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Lentigo maligna (LM) is a common in situ melanoma subtype arising on chronically sun-damaged skin and mostly affects the head and neck region. Localisation in cosmetically sensitive areas, difficulty to obtain wide resection margins and advanced patient age/comorbidities have encouraged investigation of less invasive therapeutic strategies than surgery in managing complex cases of LM. Radiotherapy and imiquimod have emerged as alternative treatment options in this context. The treatment of LM with imiquimod cream can be challenging due to the nature of the disease including its often large size, variegated appearance, involvement of adnexal structures, poorly defined peripheral edge and frequent localisation close to sensitive structures such as the eyes and lips, and elderly patients with multiple comorbidities. Prolonged and unpredictable inflammatory reaction and side effects and compliance with a patient-delivered therapy can also be challenging. In the literature to date, studies evaluating the use of imiquimod to treat LM have utilised varying methodologies and provided short follow-up and these limitations have impaired the development of clear guidelines for dosage and management of side effects. Based on our multidisciplinary experience and review of the literature, we propose practical clinical strategies for the use of imiquimod for treating LM, detailing optimal administration procedures in various clinical scenarios and long-term management, with the aim of facilitating optimal patient outcomes.

Introduction: Hair colour is determined by varying ratios of black-brown eumelanin and reddish-brown/reddish-yellow pheomelanin. Hair colour change has been reported with cancer therapies. Radiotherapy (RT) usually causes temporary epilation to permanent alopecia. A change in hair colour following radiation is rare and usually results in depigmentation. There has only been one other case reported of repigmentation after RT. Cases: We present five cases of changes to scalp hair pigmentation in the penumbral region in patients treated with volumetric modulated arc therapy (VMAT) for skin cancer. Five treated areas across four patients involved repigmentation from grey to black, and there was one case of depigmentation from brown to grey. The latter occurred during immunotherapy administration. For the two cases where recalculation of the dosimetry was possible for three areas, repigmentation changes happened at an average mean dose of 16 Gy (9.3 – 26 Gy) in an average of 26 (25 - 27) fractions; that is, 0.6 Gy per fraction at five fractions per week. Discussion: This series of six areas in five patients of hair colour change in the penumbral region of VMAT to the scalp for skin cancer is the first report of this phenomenon. Repigmentation of scalp hair with RT is rare. Even though rare, the potential for hair colour change may need to be part of the informed consent discussion in patients contemplating this treatment.

BACKGROUND: The evidence-based management of melanoma patients with a positive sentinel lymph node biopsy (SLNB) has undergone a dramatic shift following publication of practice-changing surgical trials demonstrating no melanoma-specific survival advantage for completion lymph node dissection (CLND) in this scenario. We aimed to survey how surgeons' clinical practice had shifted in response to new evidence from these trials, and at a time when there was starting to become available systemic adjuvant treatments for AJCC Stage III melanoma patients. METHODS: A web-based survey consisting of practice-based questions and hypothetical clinical scenarios about current melanoma practice with regard to positive sentinel node biopsy was developed and sent to the surgical members of a Melanoma and Skin Cancer (MASC) Trials group in December 2018. Responses were analysed using descriptive statistics. RESULTS: There were 212 invitations sent and 65 respondents (31%). Respondents were from 17 countries, 94% of whom practice in specialist melanoma centres or at referral centres. Of these 97% were familiar with the MSLT2 and DeCOG-SLT clinical trials. At survey, 5% of respondents reported routinely recommending CLND and 55% recommend CLND in selected cases. Respondents were most likely to recommend CLND when multiple SLNs were positive. Important factors for surgical decision-making mentioned included size of SLN deposit, number of positive SLNs and likely compliance with the recommended surveillance regimen. CONCLUSION: In line with rapid adoption of published evidence, surgical management of Stage III melanoma has altered significantly, with few surgeons within the cohort now performing routine CLNDs after positive SLNB.

Dialogue between diverse publics and scientists is essential to ensuring that fast-moving research such as neuroscience delivers knowledge and technologies that meet society’s needs, and align with its values. In Australia, neuroscience engagement programs typically promote brain research to the publics, rather than seek their input. We argue for a shift to Responsible Research and Innovation (RRI)-type engagement, where scientists share their knowledge, and non-scientists share their attitudes, needs, insights and expectations, starting early in the technology-development pathway. This would allow the developmental pathway to be modified to meet society’s needs and mores. We have developed a prototype RRI engagement program for neuroscience, adapted to local Australian conditions, called The Brain Dialogue. Our preliminary results suggest it is possible to alter developmental pathways. Here, we describe its components: knowledge sharing; structured issues-driven activities that include diverse st...

Objective: Treatment with immunotherapy has positively changed the long-term outlook of many patients with advanced melanoma; however, fatigue is a common and debilitating side effect. Evidence indicates exercise can improve treatment-related fatigue for patients receiving chemotherapy and radiotherapy. However, currently little is known about exercise behaviors and preferences of patients receiving immunotherapy. This project aimed to describe self-reported levels of fatigue related to immunotherapy; patient perspectives of exercise behaviors; and barriers and facilitators to engagement in exercise for patients receiving, or recently completed immunotherapy for unresectable stage III and stage IV melanoma. Method: A cross-sectional purpose-built survey was distributed to members of the Melanoma Patients Australia closed Facebook group via an online survey platform. The survey remained active for 1 month, with 3 posts during this time inviting members to participate. Results: A total of 55 responses were collected. Just over half the participants (n = 31; 56%) described exercising while receiving immunotherapy, with walking as the most common activity (n = 24; 77%). Participants described a range of physical and emotional benefits of exercise, the most predominant being fatigue reduction. Barriers to exercise also included fatigue and competing physical demands at home or work. Patient understanding of what constitutes exercise appeared to differ from clinical classifications. Conclusions: Results from this study indicate that patients are engaging in exercise while receiving immunotherapy, with the intent of mediating treatment-related fatigue. Identification of preferred exercise activities and barriers will assist in developing tailored exercise interventions for this cohort.

IntroductionThere is increasing evidence demonstrating the benefits of exercise in counteracting cancer treatment-related fatigue. Immunotherapy is an established treatment for advanced melanoma, and is associated with fatigue in a third of patients. The safety and efficacy of exercise in counteracting treatment-related fatigue in patients with advanced melanoma receiving immunotherapy are yet to be determined. This study aims to assess the safety, adherence to and acceptability of a mixed-methods parallel-group, pilot randomised controlled trial of a personalised, 12-week semi-supervised exercise programme prescribed by an exercise physiologist (iMove) in 30 patients with stage IV melanoma scheduled to commence immunotherapy: single agent ipilimumab, nivolumab or pembrolizumab, or combination ipilimumab and nivolumab. The trial will be used to provide preliminary evidence of the potential efficacy of exercise for managing fatigue.Methods and analysisThirty participants will be recruited from a specialist cancer centre between May and September, 2019. Participants will be randomised 1:1 to receive iMove, or usual care (an information booklet about exercise for people with cancer). Feasibility data comprise: eligibility; recruitment and retention rates; adherence to and acceptability of exercise consultations, personalised exercise programme and study measures; and exercise-related adverse events. Patient-reported outcome measures assess potential impact of the exercise intervention on: fatigue, role functioning, symptoms and quality of life. Follow-up will comprise five time points over 24 weeks. Physical assessments measure physical fitness and functioning.Ethics and disseminationThis study was reviewed and approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/48927/PMCC-2019). The findings from this trial will be disseminated via conference presentations and publications in peer-reviewed journals, and by engagement with clinicians, media, government and consumers. In particular, we will promote the outcomes of this work among the oncology community should this pilot indicate benefit for patients.Trial registration numberACTRN12619000952145; Pre-results.

Background There is a lack of consensus regarding optimal surgical excision margins for primary cutaneous melanoma > 1 mm in Breslow thickness (BT). A narrower surgical margin is expected to be associated with lower morbidity, improved quality of life (QoL), and reduced cost. We report the results of a pilot international study (MelMarT) comparing a 1 versus 2-cm surgical margin for patients with primary melanoma > 1 mm in BT. Methods This phase III, multicentre trial [NCT02385214] administered by the Australia & New Zealand Medical Trials Group (ANZMTG 03.12) randomised patients with a primary cutaneous melanoma > 1 mm in BT to a 1 versus 2-cm wide excision margin to be performed with sentinel lymph node biopsy. Surgical closure technique was at the discretion of the treating surgeon. Patients’ QoL was measured (FACT-M questionnaire) at baseline, 3, 6, and 12 months after randomisation. Results Between January 2015 and June 2016, 400 patients were randomised from 17 centres in 5 countries. A total of 377 patients were available for analysis. Primary melanomas were located on the trunk (56.9%), extremities (35.6%), and head and neck (7.4%). More patients in the 2-cm margin group required reconstruction (34.9 vs. 13.6%; p p = 0.036). After 12 months’ follow-up, no differences were noted in QoL between groups. Discussion This pilot study demonstrates the feasibility of a large international RCT to provide a definitive answer to the optimal excision margin for patients with intermediate- to high-risk primary cutaneous melanoma.

This chapter outlines the undergraduate experience of students in the Bachelor of Communication at the University of Newcastle in Australia where the theories about creative practice are coupled with the teaching, in this case, of media practice and production. While our higher education students, studying media production, are led toward very specific creative projects, ones they develop and work on themselves, this approach to their creative education would not work if they were not, firstly, given some grounding in the ideas that led up to these actions and practices. Our approach of heavily interlinking theory about creativity with creative media practice has produced an iterative set of learning cycles that enable students to frame and inform their practice as they develop as practitioners. In doing so, they acquire a set of tools and a research grounded language they can increasingly apply to their own creative practice. They begin to analyse what they do while they are also learning how to do it. This process is staged across three years, from introduction of the ideas through to consolidation, and by the time they reach the capstone creative production course they are well prepared. They enter this course with a highly relevant set of pragmatically useful skills to engage in and use to think deeply about their own creative practice. This is not just the development of technical skills but a solid and well integrated melding of theory with practice.

This chapter takes these ideas and introduces a model we believe helps in educating higher education students for creativity. This model, given the emphasis that we have placed on it in this narrative, is based, of course, on the systems model of creativity but adapted for the educational setting by Michael Meany. His paper, ‘Creativity and Curriculum Design: An Integrated Model’ (Creativity and curriculum design: An integrated model. In F. Martin (Ed.), Refereed Proceedings of the Australian and New Zealand Communication Association Conference 2017 – Communication worlds: Access, Voice, Diversity, Engagement. ISSN 1448–4331. http://www.anzca.net/conferences/past-conferences/, 2017), which we have drawn on here, sets it out in full. We have used this model as a framework to educate our students for creativity and it has begun to be adapted successfully in a few cross-cultural settings that we believe indicates its more general applicability across other institutional and sociocultural settings around the world. Just as Anna Craft’s work was strongly centred on the UK context and ‘her work always approached the problem with an eye to the global context’ (Harris, Creativity and education. Basingstoke: Palgrave Macmillan, 2016, p. 12), we also feel our work is ‘applicable to diverse contexts’ (ibid.). For us, designing a curriculum based on the systems view of creativity takes account not only of a broad range of pedagogies, but more importantly, focuses on the intersections between creative agents, in this case our students, and the broader social and cultural contexts they intersect with as we ‘create and maintain the conditions in which creativity can thrive’ (Lucas, Creative teaching, teaching creativity and creative learning. In A. Craft, B. Jeffrey, & M. Leibling (Eds.), Creativity in education. London: Continuum, 2001, p. 35) using a Systems Centred Learning (SCL) approach devised from within a particular higher educational setting.

The writers interviewed for this research on creativity in Australian fiction writing all tell different stories: literary fiction, young adult, romance, science fiction, crime, fantasy, children’s books. The ways in which these writers tell their stories is also varied: unusual narrators, integrating multimedia, a pared-back writing style, revelling in the complexity of language. These differences can also be seen in their audiences and formats, ranging from picture books for those who are learning to read to large print books for those who have been reading for more years than they can remember. Some works are published as stand-alone novels; others have been published as a series of interconnected works.

In the original article John F. Thompson was inadvertently omitted as an author. The author list is updated as shown in this correction.

Background Brain metastases (BMs) are common in melanoma patients. Adjuvant whole brain radiotherapy (WBRT) following local treatment of intracranial melanoma metastases with neurosurgery and/or stereotactic radiosurgery is controversial. A randomised trial is needed. However, accrual to WBRT trials has been problematic. A pilot study by Australia and New Zealand Melanoma Trials Group (ANZMTG) was conducted to see if accrual was feasible. Methods Sites canvassed for interest included those who treat melanoma patients, had a proven accrual in previous melanoma trials and who had the relevant infrastructure support. Feasibility forecasts from interested sites were sought. These were compared to the patient numbers documented in the research contracts. A target accrual of 60 patients in 2 years was set. Funding was sought for the pilot study. Basic demographics of the pilot study cohort were collected. Results The first centre opened December 2008; the first patient was randomised in April 2009. The pilot accruing period concluded in September, 2011. In 30 months, 54 patients from 10 of a total of 17 activated sites in Australia (39, 72%) and in Norway (15, 28%) had been accrued. Feasibility forecasts predicted 133 trial eligible patients per year (including 108 Australian + 25 International patients). Site estimates generally overestimated accrual with 4 of 17 active sites estimating within 50% of target numbers. Sites with patient estimates calculated from records were more accurate than those estimated from memory. The overall recruitment target was lower in the research contracts when compared to the feasibility evaluation. Basic demographics of the pilot study revealed 62% of patients were males; 58% had a single metastasis, 28% had two and 14% had three metastases. 12-month overall survival was 50%. Conclusions Despite only 54 patients and not the full 60 patient target being accrued in two years the Trial Management Committee and Data Safely Monitoring Committee approved the continuation of the pilot study to the main trial. On the basis of this successful pilot study, funding was achieved for the full study. 143 patients of a target of 200 have been randomised by June 2014.