Pioneering Test Predicts Return of Malignant Melanoma - Medscape

Scientists at Newcastle University have identified the mechanism for skin cancer growth.

Their research, published in the British Journal of Dermatology , describes how early-stage melanomas at risk of spreading secrete a growth factor, called TGFβ2, which causes the reduction, or downregulation, of the proteins AMBRA1 and Loricrin, both of which are found in the skin overlaying the tumour. The growth factor TGFβ2 also causes the loss of claudin-1, which in turn leads to loss of skin integrity, facilitating ulceration.

Senior author Professor Penny Lovat, Professor of Cellular Dermatology and Oncology at Newcastle University, and Chief Scientific Officer at AMLo Biosciences, explained: "AMBRA1, Loricrin and Claudin 1 are all proteins key to maintaining the integrity of the upper layer of the skin," and that the loss of these proteins causes gaps to develop, allowing the tumour to spread and ulcerate - a process associated with high-risk tumours.

Professor Lovat likened the process to that of "mortar and bricks holding together a wall", with the loss of these proteins being "like the mortar crumbling away in the wall."

According to Cancer Research UK, there are over 16,000 new cases of melanoma skin cancer each year in the UK, with over 2000 deaths annually. After being surgically removed, primary tumours are histologically staged, with even low risk cases being followed up for a number of years, a process that can be time-consuming for patients and costly for the NHS.

Some reassurance for those with melanoma

The creators of the new test say that it is these low-risk patients that the test is able to identify, offering a degree of reassurance to those diagnosed with the disease, and potentially reducing the number of hospital clinic visits they require.

Professor Penny Lovat commented: "Our test offers a personalised prognosis as it more accurately predicts if your skin cancer is unlikely to spread."

She added that the test will aid clinicians to identify genuinely low-risk patients diagnosed with an early-stage melanoma, reducing the number of follow-up appointments for those identified as low-risk. It, therefore, offers the opportunity to save the NHS time and money.

Excellent news for those with skin cancer

Phil Brady, chief operating officer of the British Skin Foundation, echoed Professor Lovat's comments saying: "The test can alleviate stress and anxiety for patients caused by this potentially deadly skin cancer, whilst increasing efficiency and reducing costs to the NHS."

Professor Nick Levell, consultant dermatologist & British Skin Foundation spokesperson, who has not been involved in the research, commented how the arrival of the test was "excellent news", adding that "people at low risk can be reassured and will not have to attend hospital so often for check-ups".

The development of the new test AMBLor® has been led by Professor Penny Lovat at Newcastle University, UK, in association with the University spin out company AMLo Biosciences, and is accredited by the National Accreditation Body for the United Kingdom (UKAS). The test involves tissue sections from the standard biopsy being sent in the post to the lab for analysis and costs £293 plus VAT. Currently available through a private referral service, the Newcastle team have applied for the test to be made available on the NHS.

Cosgarea A.T., McConnell T, Ewen D, et al. Melanoma secretion of transforming growth factor-β2 leads to loss of epidermal AMBRA1 threatening epidermal integrity and facilitating tumour ulcerationI. Br J Derm. First published: 13 November 2021 https://doi.org/10.1111/bjd.20889